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ANTHROPOMETRY 



AND 



Physical Examination. 



A BOOK 



FOR PRACTICAL USE IN CONNECTION WITH GYMNASTIC WORK AND 

PHYSICAL EDUCATION. 



BY 

JAY W. SEAVER, A.M., M.D., 

President of the Chautauqua School of Physical Education. Lecturer on Physiology and 

Anthropometry in the New Haven Normal School of Gymnastics. Ex-President 

of the American Physical Education Association. Member of the 

Connecticut State Medical Society., etc. 



NEW HAVEN, CONN. 
1909 






/ 



Copyrighted 1909. by Jay W. Seaver. 



i • • 

PRESS OF 
IE CURTISS-WAY CO. MERIDEN, CONN. 



fcCLA256144 



PREFACE. 



The purpose of this book in its first edition was to place 
in the hands of directors of gymnasia, who were expected to 
examine people and prescribe exercise for them, a manual 
that should be a constant guide in securing measurements, 
and an efficient help in pointing out the vital matters that 
should be considered in making a physical diagnosis, or an 
estimate of the organic condition of the various parts of the 
body and their habit of action.' 

The purpose of the present book is the same as that of 
the former editions. The failures of the last have been partly 
eliminated and the methods of measuring more carefully dis- 
cussed and illustrated, as well as the tabulation and compari- 
son of material. 

The instruments for securing more exact data, especially 
in new lines of research, have been given more attention, as 
it is believed that the most valuable anthropometric work 
of the future will be done without attributing so much value 
to space relation or size. The important question will be, 
what can the human machine do? and not, How large are its 
various parts ? 

I have been more and more deeply impressed with the 
value of the percentile method for the analytical study of 
human measurements and I have tried to give a clear concep- 
tion of the processes by which a percentile table is computed, 
so that the student may have a full appreciation of the signifi- 
cance of the table and its various grades. 

To the investigators in this new field of study, who have 
already added much to our knowledge of the working power 
of the human body, I am especially indebted for much new and 
valuable material. I wish also to acknowledge the many cour- 
tesies that I have received from other authorities who have per- 
mitted the use of material for which credit is given in the text. 

New Haven, Conn., June, 1909. 



CONTENTS. 



CHAPTER I. 

HISTORY OF ANTHROPOMETRY. 

Its source in art. — Greek standards. — Roman and Egyptian can- 
ons.— German and modern art proportions. — Anthropologi- 
cal purposes. — Its methods. — Pedagogical purpose. . . 7-16 

CHAPTER II. 

RECORDS AND INSTRUMENTS. 

Description of modern instruments. — The various books, cards, 
charts, etc., for general and private use. — What points should 
be noted. . . . . . . . . . . 17-31 

CHAPTER III. 

WHAT TO MEASURE AND HOW TO MEASURE. 

The technique of measurement. — The personal element. — The 
official list of items and rules of the American Assoc, for the 
Adv. of Physical Education. — Criticisms and suggestions. 32-56 

CHAPTER IV. 

PERSONAL HISTORY AND EXAMINATION OF THE SPECIAL SENSES. 

The private record. — Family history. — Importance of the sense 

organs. — Directions for examining the eye, ear, etc. . . 57-67 

CHAPTER V. 

TEST OF STRENGTH. 

Importance for prescribing exercises. — The mercurial dynamome- 
ter. — Method of using. — Results obtained. — Caution. . . 68-76 

CHAPTER VI. 

SPECIAL INSTRUMENTS. 

The pelvic obliquity and its measure. — Instruments. — The length 

of legs. — The deviations of the spine, etc. .... 77-85 

CHAPTER VII. 

GRAPHIC ANTHROPOMETRY. 

The tabulation of data. — Averages, means, percentages etc . 86-113 



Contents. 
CHAPTER VIII. 

THE LAW OF GROWTH. 

The increase in height and weight from birth to maturity, in males 

and females. ....... . 11-4—127 

CHAPTER IX. 

THE PERCENTILE METHOD OF TABULATION. 

The preparation of a table. — Probable Deviation. . . . 128-134 

CHAPTER X. 

EXAMINATION BY INSPECTION. 

Training the eye. — What is to be seen from various aspects. — 

Table 135-146 

CHAPTER XL 

EXAMINATION BY PALPATION. 

Methods and results. — Normal and abnormal conditions. — Tumors. 147-151 

CHAPTER XII. 

EXAMINATION BY AUSCULTATION AND PERCUSSION. 

Methods. — Areas. — Normal sounds of lungs, heart, etc. — Abnormal 

sounds. .......... 152-162 

CHAPTER XIII. 

THE SIGNIFICANCE OF CERTAIN PHYSICAL SIGNS. 

Discussion of heart sounds. — Sphygmograms. — Table of heart 

sounds. .......... 163-173 

CHAPTER XIV. 

PRESCRIPTION OF EXERCISE. 

The standard of physique. — Respiratory inefficiency. — Neuras- 
thenic cases. — Circulatory disturbances. — -Prescription form. 174-184 

CHAPTER XV. 

THE EXAMINER HIMSELF. 

The need of physical training and the standard for the examiner. — 

Personal advice. ........ 185-189 



Bibliography. .......... i-iv 



History of Anthropometry. 



CHAPTER I. 



HISTORY OF ANTHROPOMETRY. 



There can be no study of more interest than that which 
pertains to human life and development. It is the center 
around which all thought and all energy crystallizes. Youth- 
ful ambition, parental solicitude and mature counsel all aim 
at the elevation of life to a higher standard and more com- 
plete form; the child is to be better than the parent, the race 
is to evolve toward perfection. 

The highest ideal of art has been to portray life in its 
most perfect form, whatever may have been the vehicle of 
the thought: stone, color, tone or word. The outward form 
and its action has also become the test of the inward man; 
the thoughts, the impulses, the feelings, are recognized as 
having a physical basis that can be measured in some way 
and thus serve as a partial guide to the possibilities and proba- 
bilities of the future. Psychology looks for its material in 
the physical data that can be gathered, and no longer has 
its roots in speculation and personal opinion, but in physi- 
ology. 

A determination of the law of physical growth for the 
human animal has done more to correct educational methods 
than any other influence in pedagogy. Keen observation 
had made great teachers before, but their methods were never 
reduced to law. The nearest approach to this was the establish- 
ment of the kindergarten by Froebel. But even here the 
establishment of the fact of a normal development of the control 
of fundamental muscles before the accessory has introduced 
vast improvement into his method. 

We must study then to "know ourselves" physically if we 
are to train ourselves into the highest type of mental devel- 
opment as well as into the perfection of health and bodily vigor. 

In studying the law of organic growth it became necessary 
to record in definite terms the changes that characterized the 
various periods of life, and measurements of size and form were 
made. Thus the knowledge of modern human proportions 



8 History of Anthropometry. 

have been derived from the measurements of living persons 
of all ages and of both sexes. For this process, Quetelet coined 
the apt word — Anthropometry. 

In considering the science of anthropometry it may be 
worth our while to glance somewhat briefly at its history. 
It is young as compared with other sciences, but was devel- 
oped primarily for purposes of art, rather than for those of 
physiology or anthropology; and art, which is said to be "the 
daughter of the imagination," did not consider originally the 
true proportions of the human body, but tried to represent 
an ideal that corresponded closely to the modern convention- 
alized forms, or so-called fashion. We see this in Egyptian 
art, where both hands were made right, and where a peculiar 
facial type is given which certainly did not represent the ordi- 
nary beautiful face of the race, but an idealized face. 

The development of art gradually called for a closer ad- 
herence to the normal type of body, and probably the greatest 
incentive to imitate life came through the Greek admiration for 
the athlete ; it being a law that the successful competitor at the 
Olympic games should have his statue carved in marble. The 
influence of this custom undoubtedly modified Greek art favora- 
bly, and brought it to the highest standard that sculpture has ever 
attained. We know that certain artists, who were celebrated 
for the excellence of their work, left as their masterpieces statues 
that undoubtedly represent victors at these games. Poly- 
cleitos is said to have made five statues of victors at Olympia, 
and a head of Hera that was "like a verse from Homer." 

The study of human proportions as related to art expres- 
sion was carried to a high degree of perfection by Polycleitos, 
who, after mature study, sought to fashion a model that rep- 
resented the ideal man. While this statue, called the Dory- 
phoros or Spear Thrower, has been lost, undoubted copies of 
it, in fair condition of preservation, are extant.* 

The Doryphoros, "viriliter puer," was, in intent and by 
general consent, the representation of absolute perfection in 
human proportion. It was the canon followed by succeeding 



*See Reber's "History of Art," Waldstein's "Essays on the Art of 
Pheidias," Collignon's "Histoire de la Sculpture Grecque," and Sybel's 
" Weltgeschichte der Kunst." 



History of Anthropometry. 



schools in portraying the highly developed figures while the 
companion figure, the Diadoumenos, "molliter juvenis," con- 
structed on the same proportions of length, became the model 
of younger types. As a result of his minute study of human 
proportions this artist left a large number of statues, all of 
which are considered by art critics to be of the highest standard 
of excellence. 

The Roman sculptors to a certain extent followed the 
Greek canons, and at the same time developed original lines 
of thought in connection with human proportions. We do 
not know, however, that they derived these ideals from many 
measurements of proportions, but have reason to believe that 
they were the result of the study of graceful 
forms and of ripened judgment in regard to 
physical beauty. The table of proportions 
given by Vitruvius does not give evidence of 
actual measurements taken and compiled, but 
he probably drew on older canons — the Egyp- 
tian or the Greek. 

Among more modern artists the same effort 
to secure a law of proportion, that should apply 
to all artistic productions, has been made, and 
with comparatively little advance from ancient 
canons. The failure in these methods has been 
from the attempt to find some one part of the 
body that should be a common measure of all the 
other parts; as in the ancient Egyptian canon 
(Fig. 1), where the length of the middle 
finger was considered a common measure of 
all the other proportions, five fingers being the 
height of the knee, ten fingers the height of the 
pubic arch, eight fingers the length of the arm to the tip of 
the fingers, three fingers being the length of the head and 
neck, and the total height being nineteen fingers. 

The physiologist Carus of Dresden conceived the vertebral 
column to be the unit of measure and this he divided into 
twenty-four parts, according to the number of vetebrae, 
assigning to each the same value, as in embryonic life. 

The great German artist, Albert Diirer of Nuremberg, 
worked on a canon of proportion, considering the total height 
to be unity. The length of foot was one-sixth of this total, 




Fig. 1. 



10 History of Anthropometry. 

the head one-seventh, the hand one-tenth, etc. Diirer made 
the ratio of height between women and men as 17 to 18, while 
among English people the ratio is as 12 to 13. This showed 
his method to be that of the artist rather than of the anthro- 
pologist. The artist Schadow of Berlin saw the failure of 
Diirer's canon and drew up tables of proportions, derived 
by averaging the measures of various models. The tables 
represented each year of life from birth to maturity. 

PROPORTIONS OF THE BODY. 









Schadow 


BOWDITCH 


Porter 


Hastings 


Age 


5, 


Height 


1098 


1058 




1060 




7, 




1177 


1164 


1140 


1160 




9, 




1229 


1264 


1244 


1260 




11, 




1307 


1356 


1338 


1360 




13, 




1464 


1447 


1429 


1450 


Matu 


15, 

rity, 




1674 
1726 


1584 


1549 


1580 
1730 



This is fairly near the standard established for modern peoples as seen 
by comparison with recent anthropometric date. 

Later artists have in general endeavored to follow the 
classic canons or to educe a new modulus after the Egyptian 
type and perhaps the most successful effort toward this end 
has been that of Story,* whose method is based on the mathe- 
matical relation of certain geometric figures. 

In the middle of the last century the strong trend of study 
toward the natural sciences led to the more thorough investi- 
gation of the natural history of mankind, and several more or 
less valuable treatises were published on anthropology. This 
gave a new impulse to the study of human proportions, for in 
studying different races of men it was found that they had 
marked peculiarities of physique, as well as marked mental 
peculiarities and customs. 

About the middle of the last century Quetelet, who was at 
this time director of the Royal Observatory at Brussels, and 
a leading mathematician of his day, conceived the idea of 
assisting anthropology in its classification of human races by 
the determination of their physical proportions, believing that 
each race had such peculiarities as would constantly serve as 

*"The Proportion of the Human Figure, According to a New Canon, 
for Practical Use," — W. W. Story. 



History of Anthropometry. 11 

a means of identification. He had already published his 
book "Sur 1' Homme" in 1841 and began his work with much 
zeal, but soon found that it had a much broader scope than 
he anticipated when he began his research. He writes in 
the first chapter of his book on anthropometry, published in 
1871, that he is appalled by the magnitude of the field of re- 
search into which he has entered. However, being accus- 
tomed to deal with numbers, and having the enthusiasm of 
the true scientist, he proceeded in his work, and has given 
valuable material for all students of anthropology and anthro- 
pometry since his day. He was the first investigator to apply 
purely mathematical methods in determining the physical 
constants of the human body, and he demonstrated that the 
"binomial law," or "law of chance," applied to human propor- 
tions. This so-called law of chance, or probability, has been 
found to be true in its general application. It has been made 
the basis of more recent investigations, and has been specially 
applied in graphically representing the racial type; as, for 
instance, in the representation of the difference between tall 
and short races, as the Patagonian Indian and the Chinese. 
After establishing this law as applied to his own countrymen, 
he endeavored to determine the physical constants of other 
races, and perhaps the only criticism that can be made of his 
work is that he sometimes drew conclusions from insufficient 
data. For instance, in determining the size of the American 
Indian, * he concluded from the measurement of a few speci- 
mens that were on exhibition in Brussels that the Indian is of 
excessive height and size as compared with the ordinary Euro- 
pean, which conclusion has been found by more recent investi- 
gators to be not in accordance with the facts. He did determine 
the fact that various races follow special laws in their growth 
and development, as do the various organs, and the discovery 
of this fact has led to important results, not only in anthropol- 
ogy but in physiology, as we find that those types having 
comparatively long trunks and short limbs possess higher re- 
sisting power than the opposite types. We also find that the 
size of certain physical organs, like the chest, has a direct re- 
lation to the working power of the individual when considered 
as a machine. The relation of total size to the respiratory 

* Anthropometric, p. 54, ed. 1871. 



12 History of Anthropometry. 

power is an important physiological factor, as is also the relative 
length of different levers when the adaptability of the individual 
for special occupations is considered. It may be said that in 
more recent years the incentive to anthropometrical investiga- 
tion has not lain in artistic or anthropological lines, but in peda- 
gogical, psychological and hygienic. 

By far the greater part of anthropometrical work that has 
been done in the last twenty-five years has been done in con- 
nection with educational institutions and for educational pur- 
poses, and it may be truly said to-day that the investigators 
who are most active are the ones connected with departments 
of psychological study. The reason for this may be clearly 
seen in the fact that the racial type having been considered, 
the study of the individual for the sake of bringing him up to 
a high degree of excellence. becomes the next important duty 
of the educator. In this country especially it may be said 
that the work has tended in this particular line, while in Eng- 
land the research has been devoted to such departments as 
tend to the determination of general anthropological laws. 
In 1884 Francis Galton established in connection with the 

Health Exposition of. London a bureau of anthropometry, for 
the purpose of gathering material that should determine the 
physical constants of English men and women, and serve as 
a check on work done before on the Continent, and that might 
possibly lead to the discovery of new laws. A preparation 
for this work had been made by Charles Roberts, of London, 
when, in 1878, as secretary of the British Association for the 
Advancement of Science, he published the "Report of the 
Committee on Anthropometry," and presented some interesting 
material gathered by himself. The material gathered by Mr. 
Galton was extensive and was studied by a new method, which 
has been quite generally adopted during the last fifteen years 
and which has a high utility in showing the distribution of 
proportions. His plan, in brief, was to group all the measure- 
ments of any particular item, as height, weight, etc., into per- 
centile groups, or into such groups as represented integral parts 
of one hundred. These measurements being grouped in this 
particular way made a determination of the mean easy (Que- 
telefs "Vhomme moyen"), and showed that the proportions, 



History of Anthropometry . 13 

when so grouped, followed essentially the binomial law. This 
method enabled him to say of any given individual that he 
excelled in any item as height, a certain percentage of other 
persons, and that he was excelled by a definite percentage of 
individuals in the group with which he was compared. This, 
therefore, became a valuable method of graphically representing 
the size of any person, for, after having determined the dis- 
tribution of the sizes of any particular item, the position of 
the individual in this distribution was easily determined. If, 
then, we group all the items of measurements of a similar 
class of persons, according to the percentile form, and have 
a table prepared that shows this ■ distribution, we have an 
easy form of graphic representation. This method has been 
followed out most completely in this country as applied to the 
student classes of the community, no one as yet having under- 
taken the general measurements planned by Galton in Eng- 
land. The nearest approach to this English standard for 
mature individuals is probably found in Gould's Sanitary 
Commission Memoirs,* gathered from recruits who were ex- 
amined during the Civil War. This memoir is a fairly com- 
prehensive study of the actual and relative proportions of over 
a million men between the ages of sixteen and forty-five years. 

In our educational institutions since 1880 we have largely 
followed the example set by Dr. Hitchcock of Amherst in 
1861, by making a physical examination of the students who 
were admitted to the gymnasia connected with our colleges. 
In connection with this physical examination a measurement 
of some of the more important items has been made. This 
method has resulted so satisfactorily that it is now applied, 
not only to the students of the leading colleges and universi- 
ties throughout the land, but in very many of the better class 
of secondary and private schools. 

The data gathered and published by Dr. Hitchcock is the 
most complete regarding men in the period from 17 to 25 years 
of age to be found in this country. This work has also been 
extended by the investigations of persons who have been 
interested in physiological or experimental psychology, and 
large numbers of school children of various ages have been 
measured and tested in order to determine, so far as possible, 

*1869. Published by United States Government. 



14 History of Anthropometry. 

what relation might exist between physical condition and 
intellectual activity. Tables representing these investigations 
will be found in another part of this volume. 

In this connection we must mention the very thorough 
study of the growth of American school children made by 
Dr. Bowditch in 1877 and subsequently the result of his investi- 
gations determined for the first time the law of growth for An- 
glo-Saxon children between the ages of five and sixteen years. 
This investigation had been preceded by a somewhat similar one, 
made by Dr. Fahrner of Zurich, Switzerland,* although his 
results never received the attention accorded to the work of 
Dr. Bowditch, because that of the latter was far superior in 
accuracy and extent. Dr. George W. Peckham of Milwaukee, 
Wis., in 1880-83, made a study of the growth of school chil- 
dren, and a like investigation has been made in 1892-93, by 
Dr. W. T. Porter, upon children in the public schools of St. 
Louis, Mo., which confirmed the conclusions of Dr. Bowditch, 
and established several new facts pertaining to the physical 
and mental growth of children. 

In 1880 Dr. D. A. Sargent of Harvard University began 
the systematic measurement of students, and the compilation 
of the data- that he had gathered was published in 1893 in the 
form of percentile tables for the various years of college life 
for both men and women. The mean, or 50 per cent, record, 
•was graphically represented in plaster figures of both man 
and woman, and were exhibited at the World's Fair Exposi- 
tion at Chicago in that year, where they created a wider interest 
in the cultivation of the physical growth of students and gave 
a healthier trend to the gymnastic teaching that has followed. 
Similar, though less extensive, studies have been made by Drs. 
Hitchcock of Amherst, Hitchcock of Cornell, Gulick of New 
York City, Hanna of Oberlin and Seaver of Yale, and by Miss 
Wood of Wellesley, Mrs. Clapp of University of Nebraska, and 
Misses Cadwell and Swope of the New Haven Normal School 
of Gymnastics. 

In 1902 a study of the growth of the human body from the 
fifth birthday to the twenty-first was made by Dr. W. W. 
Hastings of Springfield. The result of his work was the pub- 
lication of a " Manual for Physical Measurements" for both 

*Das Kind tmd der Schultisch. 



History of Anthropometry. 15 

boys and girls. This book gives in percentile form the records 
of children in the public schools of Omaha, Neb., and adoles- 
cents from that state and Connecticut, in groups for each year 
of age and for convenient gradations of height. This material 
has been arranged on cards for individual use in recording 
personal measurements graphically and has thus found a wide 
field of use and has given an excellent standard by which even 
the untrained can detect at a glance the deviation from the 
standard for that type. 

In 1893-94 Dr. E. M. Hartwell made a study of the rela- 
tion of the nervous phenomenon of stuttering to growth and 
to the "specific intensity of life," .among the school children 
of Boston.* The term "specific intensity of life," is used to 
express the ratio between the number of children living at 
any age and the number dying at that age. Incidentally he 
demonstrated the direct relation between the specific intensity 
of life and acceleration of growth. 

The anthropometric method has been applied to the study 
of nervous phenomena by Francis Galton, by G. Stanley Hall 
and others, and in their relation to growth the results so far 
as published have given basis for a critical discussion of peda- 
gogical systems that is already bearing fruit. In the same 
field of inquiry are found some papers by Dr. E. W. Scripture f 
of Yale and Dr. J. Allen Gilbert. J 

Dr. G. W. Fitz of Boston has also called attention to some 
of the nerve reactions that help to declare the condition of a 
person, § and has invented some instruments that record the 
time of reactions. In foreign countries the study of physical 
data obtained by anthropometric tests has been carried to a 
high degree of perfection along physiological lines. Axel 
Key of Sweden has studied the relation of growth to tem- 
perature and climate, as marked by the seasons of the year, 
and to the pubertal period. Bertillon and Demeny of France, 
Mosso and Levi of Italy, Schmidt and Voigt of Germany, and 
many others have made additions to our knowledge of the 

*School Document, No. 8, 1894, Boston. 

fNinth Annual Report of American Association for Advancement of 
Physical Education, now the American Physical Education Association. 

J Studies from the Yale Psychological Laboratory, Vol. II. 

§Tenth Annual Report of American Association for Advancement of 
Physical Education 



16 History of Anthropometry. 

human body and its development. The problems of the 
future will lie in a determination of the influences affecting 
the neuro-muscular mechanism, and its dominating center, 
the intellect; the exact values of heredity and nurture as the 
determining factors of a large part of life; and the evolving 
of a pedagogical system that shall train the young to the highest 
possibilities of their faculties. 



Records and Instruments. 17 



CHAPTER II. 

THE RECORDS TO BE KEPT AND THE INSTRUMENTS TO BE USED. 

For taking the measures of a person several instruments 
are needed, but the outfit may be very simple. For several 
reasons the record should be taken and kept in the metric 
system: 1st. It is the scientific standard in use in all coun- 
tries, and is in use in every other department of scientific 
investigation in this country. 2d. It enables one to be very 
accurate without trouble, as the unit is very nearly one twenty- 
fifth of an inch. 3d. There are no fractions to complicate 
compilation, or computations, or records. 4th. It helps to 
introduce an improved system of weights and measures into 
general use, and as the ordinary person has no idea whether 
his record in English units is large or small, but only judges 
by comparison with the standard, he will get as correct an 
idea by the metric system as by any other. 

The record book should be made of the best ledger paper 
and ruled transversely into spaces enough for all the items to 
be recorded. The perpendicular ruling can be made to divide 
the space into six columns, for the records when measure- 
ments are repeated. This will enable one to see at a glance 
what the change has been in any item, from time to time. 
If the space is economized, there will be plenty of room on the 
two pages that face together to record the measures of three 
individuals, six times each, and keep such items of history as 
should appear in such a book. The list of items recorded will 
be seen on a later page. 

The books should be bound in volumes of about one hund- 
red and fifty leaves, with heavy leather, as they are handled 
frequently. 

A second way of keeping the records, that has advantages 
in compiling the figures, or tabulating, consists of a card, with 
all the items of measurements and room for two records. These 
cards are simply filed in alphabetical order and kept for reference. 
In tabulating results they are assorted into piles representing 



18 Records and Instruments. 

various grades of value that may have been decided upon for 
any item, as height, or weight, etc. . It is not a desirable form 
for a permanent record but, as the personal property of the 
examiner, is preferable to a book. 

In the form of record book devised by Dr. Gulick for use 
in Y. M. C. A. work, the historical data are placed at the top 
third of the page, the remainder being divided into a column 
for prescription, and several narrow columns for measures. 
The number of items measured is smaller than the list pre- 
scribed by the American Physical Education Association. 

It would seem that the card system of record could be 
used profitably in Y. M. C. A. work, as there is no special 
reason for permanently keeping the data except at some central 
bureau, where they can be. tabulated for scientific purposes. 
In schools and colleges a permanent record is very important 
for history and comparison. 

A method of duplicating a record for the benefit of the 
person measured has been suggested by Dr. E. Hitchcock, 
Jr., in connection with his graphic chart described later, and 
consists of a duplicate page to be inserted under the record 
page with a sheet of carbon paper between. By writing the 
record with a stiff pen the figures are duplicated on the chart 
page. 

Another very satisfactory method of recording measures 
is by the author's anthropometric table bound in book form 
and the measures indicated on it by dots and lines; or the 
actual record can be written in the blank spaces at top or bottom 
and the graphic indications marked afterwards. This gives 
a person looking over the record for special cases a compre- 
hensive knowledge of the special form of the subject at a glance, 
where the examination of a list of measures even by an expert 
would be long and unsatisfactory. On the back is printed the 
following blank for historical data and a complete report on the 
physical conditions not capable of size relations. There is 
also abundant room for notes on the further development of 
the case, and the special exercises prescribed. 



Name, or number 

Birthplace Date of Birth. 

of Father 

"Mother 

" Paternal Grandfather 



Records and Instruments. 19 



Birthplace of Paternal Grandmother 

" Maternal Grandfather 

Grandmother 

Occupation of Father 

Father died of 

Mother " " 

Common diseases in family 

Resembles in physical build, Father's, Mother's family 

Accidents and surgical operations 

Diseases 

Condition of eyes, Vision *' *' color-blind. 

ears hearing nose : 

muscles hard, soft, medium 

digestive organs bowels 

kidneys skin 

lungs former diseases of ..... . 

heart pulse 

nervous system, sleeps. 

spine 

shoulders legs 

Previous work or exercise 

health 

Color of hair 



eyes 

Use of tobacco tea coffee alcoholics 

Notes 



A card containing blanks to be filled with the historical 
matter by the person to be examined saves much time for the 
examiner and should always be used. The following form is 
serviceable : 

Volume page No 

Your appointment for examination is 

at M., at room Gymnasium. Please 

fill out this blank and bring it with you at that time. 

As no name is attached, the data here given will be strictly private, 

and will be retained by for statistical pusposes. 

Date of birth 19 

Birthplace of Self, Town. . . . State 

" Father, State 

" Mother, " 

" Father's father, State 

" Father's mother, " 

" Mother's father, " 

11 Mother's mother, " 

Father's occupation 



20 Records and Instruments. 

Do you most resemble your father's or mother's family in physical 

build? 

If either parent is dead, of what did father die? 

Of what did mother die? 

State any illness that has been common in the family, due to diseases, as 

follows : 

Heart Lungs 

Digestive organs Skin 

Kidneys Nervous system 

Scrofula Rheumatism 

Defective vision or physical peculiarity 

Have you ever had any illness that confined you to the bed for two weeks, 

or more ? What ? 

Have you ever had trouble with the eyes? or ears? 

Can you breathe freely through each nostril? 

Is your digestion good? Are you ever troubled 

with bilious attacks? or with constipation? 

or chronic diarrhea ? 

Is a cold more likely to locate in your nose, throat or lungs? 

Do you suffer from nasal catarrh ? 

Do you faint easily ? 

Have you ever had palpitation of the heart? 

Are your feet and hands usually cold ? 

Do you have headaches frequently ? 

Do you sleep well? How many hours? 

Do you use tobacco? In what ways? Alcoholics? 

Tea? Coffee? 

It is advisable for each examiner to keep a private book 
for containing information of a purely personal nature, and 
for the guidance of the instructor in prescribing exercise. 
This private record will give him an amount of material for 
study and comparison in a few years. 

This private book should contain a careful record of per- 
sonal peculiarities that may have a bearing on health and 
development. Any history of previous disease or accidental 
injury, even if recovery seems complete, should be recorded 
Advice in regard to exercise and the results of the advice 
should be noted. This book should be a history of the person's 
physical welfare during the past and while he is under obser- 
vation, and thus correspond to a physician's case-book. The 
examiner will learn more from this record than from the book 
recording size and strength, when he studies the result of gym- 
nastics. 

The following instruments are needed for measuring: 

1. A set of scales, with high bar for convenience in read- 



Records and Instruments. 



21 



ing. These are made with metric graduation and English. 
(Fig. 2). 

2. A graduated pole, with a slide moving at right angles 
on it for taking heights (Fig. 3). The arm of the slide should 
not be over 125 mm. long. The pole may have the metric 
system marked on one side, and 
the English on the other, like the one 
shown in the cut. It is essentially two 
meter sticks, on one of which is fixed 
at the end an arm 125 mm. long at right 
angles to it. A slide bearing a similar 
arm is made to run closely on the stick. 
The height is readily taken by holding the 
ends of the stick together by the splice 
with one hand while the other lowers the 
slide to the top of the head. Care must 
be taken to have the sticks perpendicular. 
The height sitting, height of pubes and 
knee are taken with the one stick, which 
is much lighter and more readily 
handled than a long pole. The same 
stick, with slide, can then be used 
for taking the breadths. It may also 
be used for taking depths, by having 
two blades in the faces of the arms 
that may be turned out when needed for use (Fig. 4). A 
stadiometer is used by some persons engaged in anthropo- 
metric work that consists of a pole mounted perpendicularly 
on a box 18 inches square and 12 
inches high (Fig. 6) . The pole carries 
a sliding arm that can be moved to any 
region for measuring heights as the 
subjects stands or sits on the box. The 
device is expensive in time required in 
using, as the subject has to be relocated 
for each record, and the stretching 




Fig. 2. 



fl.U.I.I.I.I.I.I.I.I.I.I.I.J IE 



a 



1 1 1 1 1 1 1 1 1 i-U 



.1.1.1, I.I.I 



l.l.l.l.l.l.l.l.l 



1 Metre 



Fig. 3. 



^ 



22 



Records and Instruments. 



against the pole tends to give larger records in height than 
is deserved. The constant change of position and manipula- 
tion of the subject is unpleasant for both parties and should 
be avoided when possible. 

3. A pair of slide calipers (Fig. 5), for taking breadths, 
will be needed if a pole is used for heights different from the 
one described. This adds to the expense of the outfit as well 



5 



a 



1 Metre 



'N'l'H'i'i'i'i'iWi W 



1 1 1 1 1 1 1 1 1 1 1 1 1 



fpfi 



U 



nwri 



TTT 



I'l'l'l'l'l'l 



ZDQZZ 
Fig. 4. 



as to the number of articles to be 
handled. 

4. A tape measure of steel or 
cotton (Fig. 7). The metal is un- 
comfortable to the skin, but does 
not stretch and can be kept clean. 
A linen tape stretches on being 
moistened and many subjects will 
sweat so freely as to wet a cloth tape. A painted tape is about 
as unpleasant to the touch as one of steel. A tape must be 
renewed often and as the cotton tapes are inexpensive they 
are a very desirable form for general use. 

A little instrument is made by the Narragansett Machine 

Co., at the suggestion of Dr. Gulick, 
for attachment to the end of a tape 
to indicate the proper tension, so 
that the pressure may be always 
alike (Fig. 8). It is a good device 
for the beginner, but useless after 
practice has given a habit in making 
the tension. 



ilililililililililLi.l'''''''l'l 



® J 



hlilihlilD iiiiiii.i.i.m.i 



D 



Fig. 5. 
5. Calipers for taking depths (Fig. 9). These may be of 
wood or metal and; should have large extremities, so that a 
slight variation in pressure will not vary the record greatly 
by indenting the flesh. An index should be on the instru- 
ment, for reading while in position and a spring should give 



Records and Instruments. 



23 



a constant pressure while the instrument is being used. If 
the attachment to the measuring pole shown in Fig. 4 is used, 
this instrument will not be needed. 

6. A capacity spirometer 
(Fig. 11) for recording the 
amount of air that can be inhaled 
and then exhaled, or the com- 
plemental, tidal and supple- 
mental air of respiration. 
Hutchinson's wet spirometer 
is considered the most reliable 
instrument of the kind. It 
is made in various forms and 
should record the capacity in 
liters. 

7. 1 A stethometer, or pressure 
spirometer (Fig. 10), is used by 
some persons, but is utterly 
worthless as far as information 
elicited by it is concerned. A 
person may blow by means of a 
rubber tube and suitable 
mouthpiece into an ordinary 
steam gauge that is made for 
recording low pressures, or an Fig. 6. 

instrument devised by the author may be used. A piece of 
glass tubing of 5 mm. diameter is bent into the form of a right- 




STM^DAHD 


MM | IMj| IN l| 1 Iq| 1 1 M| 1 1 o| M 1 !| | ! 1 |< 




NAR«A£lN3tTr MACHINE CO 
PWOVlOtNCE.R.I. 


mi mil 
l 


iiiiiiii 

2 


mi nil 

1 3 


IIIIIIII 

1 4 


IIIIIIII 
5 


nil nil 
e 


iiiiiiii 

7 


IIIIIIII 
1 8 


Illllllll 
1 8 


Illllllll 
1 1 


( 



Fig. 7. 




Fig. 7. 

angled triangle, having one angle of about 35°. The side ad- 
jacent to this angle should be about 400 mm. long and should 
be horizontal when the triangle is fixed against a flat wall for 



24 



Records and Instruments. 




Fig. 9. 



support. A rubber tube with a glass mouthpiece is attached 
to the short side, and mercury is drawn in to fill the horizontal 
part. Now, by blowing into the mouthpiece the mercury is 
forced up the hypothenuse of the triangle. 

The graduation is easily 
made by measuring the peipen- 
dicular line from the base to any 
point in the hypothenuse, and 
affixing a scale to the support 
back of the tube. The pressure 
will then be indicated in milli- 
meters of mercury column. 

8. A hand dynamometer 
(Fig. 12) for taking the strength 
of the flexor muscles of the fore- 
arm may be used where a uni- 
versal mercurial dynamometer 
is not available. 
There are several forms of this instrument, the more com- 
mon ones being the oval, and the form with the two sides 
always parallel (Fig. 12) , the re- 
sistance being two spiral springs. 
This second form gives all the 
fingers an equal opportunity to 
exert their pressure. A "push 
holder" and a "pull holder" (Fig. 
13) are made to use with the in- 
strument for enlarging its range 
of utility. 

9. A dynamometer for lift- 
ing with the back and legs and 
taking the strength of the pecto- 
rals and retractors of the shoul- 
ders is shown in Fig. 15. The 
instrument may be replaced for 
the first two tests by a lifting 
machine with spiral spring re- 
sistance and a graduated index applied from actual tests. 
The advantage of this latter form is the quick adjustment to 
the height of the person. 

10. Parallel bars for testing arm extensors in "Push up." 




Fig. 10. 



Records mid Instruments. 



25 



A short pair of bars (Fig. 15), about 750 mm. long attached 
to a frame with suitable braces, and made to move up and 
down against the wall in being adjusted to any height desired , 
can be used for this test and also 
for the "Pull up," or test of flexors 
of the upper arm. Otherwise a 
horizontal bar (Fig. 16), trapeze 
bar, or pair of swing rings, must be 
used for this last test. This bar 
frame should be hung with a coun- 
ter weight and latch for easy and 
quick adjustment to any height. 
The bars have an attachment for 
carrying a cord three inches above 
them, to which the chin must be 
lowered in taking the test. 

11. A stethoscope for listening 
to heart and lung sounds, etc. (Fig. 
17). Camman's binaural is a suit- 
able instrument. The soft rubber 
bell is useful at times to secure per- 
fect coaptation to the surface of the 
chest. It requires some practice to 
secure all the advantages that a 
stethoscope can give, as the pressure of the nib in the ear is 
a distraction of the attention at first, and any slight move- 
ment of the ringers on the instrument causes vibrations that 

are not understood. If 
the examiner wishes to 
hear the valvular 
sounds cf the heart, 
without the interfer- 
ence of muscular vibra- 
tion sounds he can in- 
terpose a thin cloth be- 
tween the bell and 
skin, but in general the 
instrument should be 
placed directly against the surface of the body. 

The phonendoscope, invented by Bianchi (Fig. 18), is con- 
sidered by many prominent teachers in physical diagnosis 




Frn. 11. 




Fig. 12. 



26 



Records and Instruments. 




Fig. 13. 



superior to the stetho- 
scope in some respects, 
and more desirable be- 
cause it can be conve- 
niently carried in the 
pocket without detaching 
the tubing, and clothing 
does not seriously inter- 
fere with its reception of 
sounds. A combination 
of the principles used in 
the two instruments has 
been made by Dr. Bowles, 
and the result is an im- 
provement over any of the previous means of studying inter- 
nal sounds. The Bowles stethoscope may now be obtained 
from any dealer in surgical supplies. 

In addition to the above-mentioned instruments, the fol- 
lowing are useful at times and for 
special work: 

12. A sphygmograph , or ky- 
mograph, for taking pulse trac- 
ings. Dudgeon's instrument is 
perhaps as satisfactory as any 
(Fig. 19). It is small, easily ap- 
plied, can be carried in the pocket 
and used in the gymnasium as 
well as in the office. It cannot be 
applied to all pulsating surfaces. 
Marey's instrument is used to 
some extent, but the pneumatic 
kymograph is employed in all 
physiological laboratories; and 
does very satisfactory work. 

13. A laryngoscope, rhino- 
scope, otoscope and tuning fork, 
for examining the throat, nose and 
ears. 

14. A Clinical thermometer. 

15. A Pleximeter and Per- 
cussor (Fig. 20 and 21). 




Fig. 14. 



Records and Instruments . 



27 



16. A microscope of 20 mm. focal distance for examin- 
ing the skin. 

17. A case of urinary tests for sugar and albumen. 




Fig. 15. 



Fig. 16. 



18. Test worsteds, glasses and charts, for examination of 

eyes for color blindness and errors of refraction. 

These instruments can be obtained of any first-class dealer 

in surgical instruments and opticalgoods 

except 17, which can be obtained of 

Parke, Davis & Co., or other manufac- 
turing chemists and druggists. 

The historical data that should be 

gathered at each examination are of 

varied character, and of the highest 

importance. It not only gives the exam- 
iner an idea of the 
immediate weak- 
nesses that are to 
be met and com- 
bated by proper 
advice and train- 
ing, but it places 

the law of heredity in bold relief, and 

enables the counsel to be far-reaching 

in its results. 

For instance : with a record of tuber- 
culosis, extending through two or more 

generations, there would seem to be 

sufficient warrant for advising not only 

the thorough development of the chest, 

but the careful avoidance of excessive 

Fig 17. 




Fig. 18. 




28 



Records and Instruments. 




exercise, such as would 
be required in many 
athletic sports that 
might seem, at first 
thought, especially 
suitable for a person of 
consumptive diathesis. 
To know a man well 
you must know his 
father and grand- 
father. 

Growth and organic 
perfection are gained 
only by a use of all the 
tissues — but use is one 
Fig. 19. thing and abuse quite 

another. The eye is developed and improved by a repeated 
use in distinguishing colors, shapes and sizes; but a long- 
continued strain of the eyes over a Greek or German text is 
not exactly beneficial, as the spectacle-mounted noses of our 
students, especially the Germans, bear witness. So, while a 
good run in the open air may be beneficial to a person of sensi- 
tive or weakened lung tissue, it does not follow that training for a 
mile run or a "hare-and-hounds" chase would be. 

The condition of the 
person during the pre- 
vious years of his life is 
valuable in making a 
prognosis or a judgment 
of the future history of the case, and in 
deciding what quality of endurance the subject 
possesses, for the violent exercise of one man 
is a mere nothing for another. The boy who 
comes to school from the farm or workshop 
may be no better developed than his class- 
mate who has never known what physical work is, 
and yet be able to endure twice as much pro- 
longed physical exertion. His life has been 
spent out of doors, and he takes kindly to 
out-door sports, running, football, boating, etc.; Fig. 21 




Fig. 20. 




Records and Instruments. 29 

or, if his life has been in a shop where skilled manipulation 
has engaged his energy, he prefers gymnastic exercises, be- 
comes an adept at club swinging, fencing, etc., or a good per- 
former on the bars, rings and other apparatus. 

The city-bred boy has a latent aptitude for anything, and 
with proper training is a strong competitor with his country 
classmate in every line of athletics or gymnastics, but his 
exercise will need to be progressive or he will suffer from local 
strains that may affect vital organs. 

If, on the other hand, the history discloses a previous 
life of activity and physical hardship, and the plan of life is 
directed toward sedentary pursuits, the recommendation 
must be toward retrogressive exercise. A man with benign 
hypertrophy of the heart is not in the best condition for sitting 
at a desk all day — there will be too much local congestion for 
good brain work, or the metamorphosis of muscular tissue in 
the heart itself will end in fatty degeneration, or softening, 
and impaired vitality result. This is undoubtedly the reason 
for the numerous cases of functional and organic diseases of 
the heart that are found among ex-champions. 

The history may also disclose a tendency to disease in 
the subject that will modify the prescription of exercise very 
materially, if the examiner is alive to the exigencies of the 
case and informed as to its requirements. 

On the record book, in connection with the measures, the 
subject's name and birthplace should be kept — there is no 
reason for secrecy about these matters. It is also well to add 
the birthplace of parents and grandparents to this general 
record, for it makes the material valuable in studying the 
effect of location or environment in differentiating classes or 
social groups; the occupation of the father, the resemblance 
in physical build to father's or mother's family; past exercise 
in work and recreation, pulse rate, color of hair and eyes, 
vision and hearing, use of tobacco and stimulants. In the 
private book should be recorded the cause of death of either 
parent if not living, any disease that has been common in the 
family (it is better not to use the word hereditary in this con- 
nection), such as lung diseases, heart diseases, rheumatism, 
neuroses, Bright's disease, cancer, scrofula, varicose veins, 
dyspepsia, diarrhoea, constipation, catarrh, etc.; also any 
disease that may be found affecting the subject, as varicocele, 



30 Records and Instruments. 

rheumatism, synovitis, etc., any deformity and its cause, if 
discoverable; any injury in the way of broken bones, surgical 
operations, strains, etc. ; any previous severe illness, such as 
peritonitis, zymotic fevers, etc. ; any tendency to deranged 
functional activity, as constipation, biliousness, indigestion, 
insomnia, etc. 

In this connection it may be well to call attention to the 
rule that, if a child strongly resembles in physical build the 
side of the family that has no hereditary taint, the other side 
having some pathological diathesis or dyscrasia, the proba- 
bility of his inheriting the disease is diminished. 

It is well to record the special kind of athletic or gym- 
nastic work that has been taken and whether this has been 
under the personal direction of a teacher or trainer. 

If there is any lesion of the heart or other organs that 
has been due to or been attributed to athletic or gymnastic 
work under supervision, look up the instructor and get the 
previous history of the case. You may find that the so-called 
instructor or trainer was an ex-prizefighter or dilapidated 
"bummer," but, if so, use him to discredit the popular trust 
in ignorance. If he does know his business, he will perhaps 
be able to enlighten you as to the cause of the trouble. 

It would seem to be desirable to establish some general 
system of marking physical condition so that a man who had 
been properly examined could have a statement, in such com- 
mon terms as could be understood by lay people anywhere, 
that should give his condition of health, the important items 
of his size, the condition of all his so-called vital organs, his 
strength and apparent working capacity as well as his proba- 
bility of life. Francis Gait on has called attention to this 
desideratum in a communication to the American Associa- 
tion for the Advancement of Physical Education (see report 
1891). I believe this to be a perfectly feasible matter and 
would suggest in connection with a graphic and numerical 
statement of size that there be a more extended system of 
strength tests. 

An arbitrary numerical mark could be given to represent 
the heredity, the condition of heart, lungs, digestive organs, 
kidneys, nervous system, skin, visual organs, hearing, etc. 
If these were all marked on a scale of ten, which should rep- 
resent perfect condition, lower numbers representing com- 



Records and Instruments. 31 

parative deviations from this standard, a comprehensive view 
would be given of the mechanical conditions which tend to 
make a durable as well as satisfactory machine, for from one 
point of view man may be truly considered as a machine. 
These points suggested above might well be divided into two 
classes and marked "essentials" and "desirables." Under 
essentials might be placed the condition of the heart, lungs, 
kidneys and nervous system. The other items might be 
classed as desirables but where slight deviations from perfect 
condition could be tolerated. A report of this kind would be 
of high value to an employer who might be seeking a perma- 
nent helper in any line of work. 

A very valuable work in this line has been done by Dr. E. 
E. Holt, of Portland, Me., and published in the Journal of 
Medicine and Science for September, 1904, under the title, 
"Physical Economics." The purpose of the paper is to give 
a mathematical expression for the economic or earning ability 
of a person. An analysis is made of the various sources of 
power and these factors are so combined as to give a working 
formula that may express with fair accuracy the disability 
occasioned by damage to any part of the organism. • 



32 What to Measure and How to Measure. 



CHAPTER III. 

WHAT TO MEASURE AND HOW TO MEASURE. 

In making a physical examination and measurement it is 
well to have the subject entirely nude, and consequently the 
temperature of the room must be kept as high as 75°. During 
the measurement the examiner should be alert in noticing any 
peculiarity, or deformity, or disease, or external indication of 
disease. The subject may then dress the lower extremities 
and the minute examination of the chest be continued. 

When the examination is made for an institution, and is 
to include the measurement of many men, the services of a 
clerk will save at least half of the time and leave the exam- 
iner free from merely clerical work, and enable him to give 
all his attention to the examination in hand. With such 
assistance, the fifty measurements can easily be made, after 
a little experience, in five minutes, and from fifteen to twenty 
minutes should be devoted to each individual; the latter 
amount if advice in regard to methods and forms of exercise 
and instruction concerning diet, bathing, sleep, etc., is to be 
given at the time of the measurement. To economize time, 
the specially weak or undeveloped parts should be pointed 
out to the subject himself, and the simplest exercises for de- 
veloping those parts be recommended and illustrated if possible 
at a subsequent meeting. 

A greater advantage will come from exercise if the object 
of the exercise is known than if a routine is simply followed 
without interest. A muscle will undoubtedly grow faster if 
watched and made the object of thought during its activity, 
and if attention is turned to it during its period of rest. The 
reason of this is found in the inter-relation of the trophic and 
motor nerves, and the influence of central attention on the 
latter. 

The hygienic instruction can be given by lecture to whole 
classes, and a case needing special care and supervision can 



What to Measure and How to Measure. 33 

be asked to come to your office at some other hour when you 
will have time to go over the case thoroughly and examine 
into all the details of his habits, a knowledge of which will 
alone enable you to give the best advice. This will save time 
in the examination and enable you to attend to the other 
work more privately and make your work less mechanical. 

If you are examining many cases in succession you will 
need to possess a quick memory of faces and facts or some 
notes will have to be taken at the time of examination that 
will recall the existing conditions in each case. It is well to 
train the memory in this matter, but take careful notes to fall 
back upon. A client will feel that you remember him and 
have given his case thought if you can show that you know 
just what his condition was when you saw him last. 

The number of items measured is not of so much import- 
ance as the thoroughness of the work done and the care and 
judgment displayed in discovering weak parts that can be 
strengthened, and recommending the proper remedies. But I 
would advise a strict adherence to the advanced standard of 
measurements recommended by the American Physical Edu- 
cation Association, for uniformity of methods is of great im- 
portance in giving scientific value to work of this kind. 

Then, if a person has a special desire to ride some hobby 
of his own and take such measurements as the horizontal 
length, the occipito-mental diameter of the head and the 
length of the os calcis, all of which points are of some importance 
and have a bearing on anthropology and practical anthro- 
pometry, he is at liberty to do so. 

The following technique of measuring is suggested as one 
that has been found to be the most economical in time and 
energy, and most likely to give correct interpretation of the 
physical proportions. 

First secure the height record as follows: Place the sub- 
ject in an easy, erect, standing position, with heels together; then 
step behind him and place the foot of the pole (Fig. 22) near 
the heels in the median plane and bring it to a perpendicular 
position, holding the parts firmly together with the left hand. 
With the right hand bring the movable hand of the caliper down 
upon the top of the head. Remove the pole and read the 
number indicated, as you wish to have it recorded by the clerk. 
There will be a tendency on the part of the subject to put 



34 



What to Measure and How to Measure. 



himself in an unnatural position, and while it is essential for 
the person to hold himself perfectly erect it is desirable for him 
not to stretch himself into unusual positions. If a person 
does stretch himself unduly it is well for the examiner to move 
him one or two steps before taking his height. This puts him 

off his guard and enables the examiner 
to secure his normal height record; 
or the subject may be moved to one 
side with the same result. The method 
of taking heights by placing persons 
against a wall is faulty, as is also the 
stretching a person against a fixed pole 
for the reason that it gives an abnormal 
poise. The ordinary standing height 
of persons with deep lumbar curve 
will increase by 20 to 30 mm. by 
having him stretch against a fixed sup- 
port. The time of day when the 
measurements' are taken also modifies 
the reading to some extent, the total 
height being greater in the morning 
by some 10 to IS mm. This is due to 
the elasticity of the intervertebral 
cartilages and improved tone of the 
muscles that carry the body erect. A 
series of careful experiments, extend- 
ing over a year, have been made by 
Mr. F. H. Curtiss, on three young men 
to discover the loss of weight, and gain 
in height, during sleep. The ages of the 
young men were approximately 17, 19 and 20 years at the 
beginning of the observations. His results are as follows :* 




Fig. 22. 





Age 


Weight 
(Kg.) 


Loss 
(Kg.) 


Height 
(Mm.) 


Gain 
(Mm.) 


E. 


17 


56. 


.32 


1698 


16.3 


J. 


19 


55.5 


.33 


1723 


18. 


F. 


20 


62.7 


.39 


1680 


18.8 



*Phys. Ed. Review, Dec, 1898. 



What to Measure and How to Measure. 



35 



Somewhat similar work has been done by Dr. T. A. Storey 
at Stanford University.* 

Next, step in front of the person, placing the foot of the 
pole in the median line and slightly in front of the line con- 
necting the tips of the toes. Bring the pole to a perpendicu- 
lar position so that the movable arm will rest in the sternal 
notch and read the record. Then, if the height of navel is 
seen to be more than one meter, push the sliding arm up above 
the head and place the pole near enough to the body so that 
it will touch the abdominal wall when 
perpendicular, then read. (Fig. 23). If 
the height be less than one meter use 
only the upper part of the pole, placing 
the end of it on the floor and measure as 
before. 

The height of the pubic arch is read 

from the pole while in this same posi- 
tion. In these two measures it is not 
necessary to use the sliding arm of the 
pole, although this may be done by 
reversing the pole and then reading to 
the upper edge of the slide, instead of 
the lower, in order to compensate for 
the thickness of the fixed arm that will 
lie between the floor and the beginning 
of the graduation. 

All records to this point are to be 
taken without having the subject move 
from the original position. 

Next, have the person sit on a stool 
provided for this purpose, which should 
vary in height according to the general 
height of the group to be measured, the 
essential point being to have the "thigh horizontal when the 
person is sitting. For fairly mature subjects this will be 
about 35 cm., and less for children. Standing behind the 
person, place the lower end of the upper half of the pole upon 
the top of the stool and bring the slidejiown upon the top of 
the head (Fig. 24) . Care should be taken to see that the subject 
is sitting perfectly erect and that the poise of the head is correct, 

*Phys. Ed. Review, Dec, 1901. 




Fig. 23. 



36 



What to Measure and How to Measure. 




as undue elevation or depres- 
sion of the chin seriously 
modifies the record. 

The length of trunk to the 
episternal notch is taken by 
placing the end of the pole on 
the stool between the thighs 
and then bringing the sliding 
arm down until its tip rests in 
the sternal notch with the pole 
perpendicular. 

Take the height of the knee 
by stepping to either side and 
placing one hand upon the top 
of the knee, so that the thumb 
shall press firmly into a notch 
found at the top of the fibula, 
and holding the rod in the 
other hand perpendicularly, 
bring the sliding arm up under 
the tip of the thumb and read, 
(Fig. 25). If the rod is placed close to the thumb the per- 
pendicular position will be more easily secured. There seems 
to be no reason for not making this a bone measurement, 
as it is a length of bony structure that is sought. The most 
convenient land-mark for measuring seems to be the top 
of the head of the fibula, this being 
on the outside of the leg, and on a 
level with the articular surface of the 
joint and with the upper edge of the 
biceps tendon. It is, therefore, easily 
found in all cases. 

The top of the patella has been 
used as a land-mark by some examiners 
and also a measurement to the top of 
the knee. It is obvious that neither 
of these records give the true length 
of the leg for comparison with the 
length of the thigh. 

It is convenient now to take the 
length of the feet, and the pole is 




What to Measure and How to Measure. 



37 




Fig. 26. 



applied on the inner side of the foot as it 

rests on the floor so that its fixed arm rests 

against the greater prominence of the os 

calcis, the pole touching the inner surface 

of both the heel and the ball of the foot 

(Fig. 26). This saves handling the foot 

and insures uniform accuracy. 

The subject now stands and the length 

of the arm from shoulder to elbow is 

secured by placing the forearm against the 

chest in a horizontal position. (Fig. 27.) 
The pole is applied against the front of 

the arm with the fixed arm of the caliper 

resting on the acromion process; the slid- 
ing arm is moved up against the olecranon 

process. 

The length of finger tip is next secured 

by placing the fixed arm of the caliper 

against the olecranon tip and letting the rod lie along the 

back of the forearm. Then bring the 
slide against the tip of the middle finger. 
Care must be taken not to apply the rod 
in such a way that the fixed arm of the 
caliper rests against the triceps muscle, 
but essentially at right angles to the 
humerus. There appears to be no ade- 
quate reason for taking the length of 
both right and left arm. 

The stretch of arms may next be 
taken by grasping the upper end of the 
lower half of the pole, and by applying 
the other end of it to the wall about the 
height of the shoulder of the subject, and 
directing him at the same time to put 
the tip of his finger against the wall at 
the same place. While he is doing this 
bring the second part of the rod to posi- 
tion so that when you ask him to extend 
the other arm you have everything in 
position, so that you may readily move 
Fig. 27. the slide against the tip of his middle 




38 



What to Measure and\How to Measure. 



Fig. 28. 



finger while he is in a position of complete extension. It 
will be convenient to make this the first measurement taken 
as the lower half of the rod may then be laid aside after tak- 
ing height of navel. 

Now lay aside the lower half of 
the rod and take breadth measure- 
ments, beginning with breadth of 
head.%This and the next three 
records should be taken standing 
behind the person. In taking all 
breadths, care should be taken to 
hold the rod so that the sliding arm 
may be moved by the right hand. 
Press the caliper firmly at a point 
high enough to insure including the 
broadest part of the skull, then lower 
until it touches tops of the ears, keeping the right thumb 
pressed lightly on the carriage of the sliding arm. The widest 
part will have been included. 

Great care must be exercised in securing the breadth of 
neck, as the tissue is extremely susceptible to change under 
pressure. Measurements should be taken from behind with 
the left hand resting on the left shoulder of the subject, in 
such a way that the thumb 
and forefinger can bring the 
fixed arm of the caliper to 
touch the left side of the 
neck (Fig. 28). The thumb 
of the right hand can then 
move the sliding arm of the 
caliper up to touch the right 
side of the neck and the cor- 
rect breadth be thus secured. 
I see no reason why the 
breadth of shoulders should 
not be taken at the level of 

the acromions, and have Fig. 29. 

always so taken it. This accounts for the difference in re- 
cords shown on the percentile charts of Amherst and Yale 
students. The subject should stand in easy position without 
throwing the shoulders back (Fig. 29). 




What to Measure and How to Measure. 



39 



The technique should obviously be the same for taking 
breadth of waist as for securing the breadth of the neck, ex- 
cept that the left hand should rest upon the hip instead of 
the shoulder. The record should be taken at the narrowest 
part of the trunk or over the last rib. 

After taking breadth of waist, pass in front of the subject 
and measure the breadth of chest by placing the tips of the 
caliper in the axillary spaces at the level of the nipples, taking 
care not to place them so far back as to include any part of 
the latissimus muscle. The breadth of nipples should next 
be taken from center to center if measured at all. I perceive 
no adequate reason for making this record. The breadth 
of hips should next be measured by pressing the caliper arms 
firmly against the trochanters, as this should be a bone measure- 
ment. It may be well to note that. the 
height of this diameter is the height 
of pubis. 

In recording the measurements of 
women it is advisable to measure also 
the breadth of the hips at the pelvic 
crests. This can be done without 
including muscular tissue by apply- 
ing the tips of the caliper arms to the 
outside of the anterior superior spinous 
processes of the ilii. 

The measuring pole may now have 
the attachments for taking depths 
opened on the arms as shown in Fig. 4, or the caliper (Fig. 9) 
may be used. In taking depths, care must be exercised to 
secure the normal position of the subject, as slight muscular 
movements change the depth greatly. The depth of chest is 
taken by applying one foot of the caliper to the spinous pro- 
cess, and the other to the sternum on a line between the nipples 
in such a way that the plane of the caliper will lie at right 
angles to the axis of the spine (Fig. 30). The caliper must 
be so constructed that a spring shall hold the caliper arms 
against the chest with a constant tension, and a pointer affixed 
to one arm moving along the graduated arc will indicate the 
antero-posterior movements of the sternum during respiration 
and the maximum reading indicate the depth of chest at ordinary 
inspiration. The depth of the abdomen is next secured with 




Fig. 30. 



40 



What to Measure and How to Measure. 



the caliper in the same relative position to the spine, and the 
anterior arm resting slightly above the navel. This record is 
valuable only in a general way. 

The author believes that in all cases where there is obvi- 
ous asymmetry of the chest, or where there is found pul- 
monary disease or bone deformity, it is well to take other 
depth measurements as well as those prescribed by the American 
Association. The depth of right and left sides may well re- 
ceive consideration, and their record may be taken at various 
heights and at indifferent phases of respiration for private records. 
The girth measurements should next be taken. It is con- 
venient to begin with girth of head, which should be tak- 
en round the largest part and over frontal and occipital 

prominences. The tape 
may be conveniently 
applied by holding it 
between the thumb 
and forefinger of each 
hand, with the hands 
at such a distance 
from each other that 
they shall represent 
about the distance to 
be measured (Fig. 31). 
The tape thus extend- 
ed should be lifted over 
the person's head with the examiner standing at the right 
of the subject; the hands to be raised or lowered as may 
be necessary to bring the line of tape into conjunction with 
the greatest diameter, which may be readily appreciated 
from this position. After reading the tape in position, it 
should be lowered to the neck and the record secured by measur- 
ing around the smallest part just below the larnyx. It will 
be noticed in carefully observing the contour of the neck that 
there is usually a smallest part, the neck being formed essen- 
tially by two truncated cones applied to each other. 

The tape is now removed from the neck and applied to 
the chest under the arms in such a way as to have the unit 
end lie upon the right half of the chest in front. The tape 
should embrace the lower ends of the scapulae and lie 2 cm. 
above the nipples. It is convenient to record first the normal 




Fig. 31 



What to Measure and How to Measure. 41 

chest. (It need hardly be said that no girth measurement 
should be taken with the finger under the tape, but the au- 
thor has seen this done by people of some little experience, 
especially in taking chest measurements.) Then without 
moving the tape have the subject inhale and expand the chest 
to its greatest capacity the tape meanwhile to be removed 
from the front wall by raising the ends of the tape so as to 
allow free play during expansion. After the reading is made 
have the subject exhale, flattening the chest as completely 
as possible. Apply such tension to the tape as shall keep 
it against the skin, but care must be taken that no greater 
tension is applied to the tape during the time of reading the 
record for contracted chest than for expanded chest, as will 
be the tendency. The girth of chest should then be taken 
below the pectoral muscle about 8 cm. below the nipple in both 
forced inspiration and expiration. This is usually called 
the girth at the ninth rib, the tape crossing the ninth rib in 
the axillary space. 

The girth of waist should be measured around the smallest 
part of the trunk. 

Care must be taken in securing this record that the sub- 
ject does not contract the abdominal muscles and thereby 
diminish the normal size of the waist. If the subject does 
this, I would advise the examiner to pass the tape line down 
and secure the girth of hips, then secure girth of waist, which 
will then be found usually in normal form. 

In measuring girth of hips the tape should pass horizon- 
tally over the greatest protrusion of the gluteal muscles, the 
subject standing with heels together as in heights and breadths. 
After the tape has been put around the trunk for the first 
chest measurement it should not be removed until the girth 
of hips is read. 

It is convenient now to begin the measurement of the 
limbs, and the subject should stand with the feet about 15 
cm. apart with the weight borne equally upon them. 

Beginning with the right biceps place the tape around 
the largest part, in a plane at right angles to the axis of the 
humerus, while the muscle is strongly flexed. The arm is 
then straightened and the tape placed midway between the 
ends of the humerus for girth of arm (Fig. 32). The position 
of the greatest enlargement during the contraction varies 



42 What to Measure atid How to Measure. 

greatly in different people, being dependent on the relative 
lengths of the tendonous portions. It seems desirable that 
we should have a record for both biceps and arm, as a relative 
size of these two records gives a strong indication of the muscular 
condition of the subject, for if the size be largely made up of 
fatty tissue, the difference between the two records will be 
comparatively small. 

The girth of elbow is supposed to indicate to some extent 
the bony development of the subject, if measured around the 
condyles. However, this record is always found to be large 
if the girth of the forearm be large, since the measurement 
must of necessity include heads of both flexors and extensors 

^^^^^ of the forearm, and these are 
I the muscles that are measured 
I over their largest parts in the 
I forearm. 

I prefer to have this girth 
I indicate the extent to which 
I the tissues of the arm extend 
I to and coalesce with the tissue 
I of the forearm. Consequently, 
I I measure above the internal 
I condyle around the smallest 
I part of the arm. The dif- 

_j ference in the two methods is 

shown on the percentile tables 
from Amherst and Yale students. 

The tape is next lowered to the largest part of the fore- 
arm, while the hand is tightly closed, and the girth recorded. 
It is then lowered to the smallest part of the wrist, i. e., below 
the styloid process, while the thumb is kept well in toward the 
palm. 

The thigh is next measured close to the gluteal curve and 
the tape then lowered to the knee over the center of the patella. 
The girth of calf is taken around the largest part; the ankle 
around the smallest part. The tape is then removed and 
placed around the instep over the tarsometatarsal joint. The 
left side is then measured in the same order. The examiner 
stands at the side of the subject while securing these limb 
measurements, rather than in front (see Fig. 31). 



Fig. 32. 



What to Measure and How to Measure. 43 

REPORT OF THE COMMITTEE ON REVISION OF PHYSICAL 

EXAMINATION. 

At the convention of the American Physical Education 
Association, held in Detroit April 6-9, 1903, there was ap- 
pointed a committee to "revise the Physical Examination." 
This committee consisted of Dr. Paul C. Phillips, chairman; 
Dr. Dudley A. Sargent, Dr. George L. Meylan, Dr. William 
W. Hastings and Dr. C. E. Ehinger. 

The committee decided it was advisable, in their revision, 
to publish a minimum list of measurements and strength 
tests, containing the most essential records. This decision 
was based largely on the demand of physical directors in many 
fields for a shorter list, which would require less time to take, 
promote accuracy in the taking and give more time for the 
medical examination and study of the individual. Some, 
it was thought, would adhere to the old list, or a greater portion 
of it, where time and means were obtainable, but the minimum 
list would constitute a basis to which additions might be made 
to suit the individual field. 

It was recognized, moreover, that the report of the former 
committee represents quite inadequately the entire list of 
qualities, now measurable, which it is, in general, desirable 
to include. 

It was deemed wiser, however, for the present, not to 
incorporate purely psycho-physical or anthropological tests 
in a minimum list. 

It seemed inadvisable to attempt to modify this list to 
suit perfectly the requirements in the various fields of work. 
The committee recommends, however, a list for the public 
schools. 

As a basis of selection value to the individual examined 
was given first place, the value to science in general being 
considered secondary. For this reason many measurements 
of great anthropological value were omitted. 

In the case of a few the preponderating argument was 
the interest of the individual in the measurement or test. 

Inability to change a measurement by exercise was con- 
sidered a strong argument against its retention. Those measure- 
ments and tests which together formed the best index of 
the individual's organic vigor or vitality were voted most 
valuable to him. Hence the large proportion of measure- 
ments of the body proper. 

The committee did not reduce materially the data required 
in family and personal history (as this is generally given on 
a blank by the one examined, and so requires little of the 



44 What to Measure and How to Measure. 

director's time) but attempted mainly to make more definite 
the questions in order to obtain more definite information 
regarding nationality, birthplace, health of ancestors, etc. 

It seemed desirable to get fuller information regarding 
not only the organic but the functional disturbances of the 
individual and if necessary of his ancestry. Hence the ques- 
tions added. 

PERSONAL AND FAMILY HISTORY BLANK. 

Date 19 

Name in full 

Birthday, year month day 

Age in years and months 



FAMILY HISTORY. 

Nationality of paternal grandfather 

Nationality of paternal grandmother 

Nationality of maternal grandfather 

Nationality of maternal grandmother 

Residences of father before your birth 

Residences of mother before your birth 

Note — Name the towns or cities, stating length of time lived in each. 
Occupation of father before your birth 

HEREDITARY CONDITIONS. 

Do you resemble your father's or mother's family in physical character- 
istics ? 

Pather died of at: years of 

age. (If living, how is his health?) 

How was it before your birth ? 

Mother died of at years of 

age. (If living, how is her health?) 

How was it before your birth ? 

Number of brothers and sisters living dead 

Causes of their deaths : 1 2 3 

Check all of the following diseases which have been common in your 
ancestry: Rheumatism, Consumption, Heart disease, Kidney 
disease, Cancer, Nervous affections, Digestive troubles. 

PERSONAL HISTORY. 

Residence. State where the first 17 years of your life have been spent 

giving your age at each residence: In the city 

Suburban town (under 8,000 pop.) 

Country town (under 8,000) 

Country 

Viz.: City 1-17; or country 1-10; country town 11-17. 
Occupation. What has been your occupation (work) since boyhood? 

Mental physical 

In what forms have you taken your exercise (recreation) ? 



What to Measure and How to Measure. 45 

Sicknesses. What diseases have you had? Name all, giving dates and 
length of time each sickness kept you in bed ' 



State any ill effects of these sicknesses which remain. 
Ailments. 

Is your appetite good? Are you ever troubled 

with indigestion ? constipation? bilious attacks? 

Are you subject to colds? — nose, throat, or chest? 

Can you breathe freely through either nostril ? 

Are you subject to headaches? 

Do you have trouble with your eyes ? ears ? 

Did you ever faint ? Do you get out of breath easily? 

Do you sleep well? How many hours average? 

Average number of hours spent in the open air each day? 

MEDICAL EXAMINATION. 

Vision : R= L= 

Hearing : R L= 

Skin: 

Form and Posture. 

Head, spine shoulders 

Chest abdomen 

Pelvis legs 

Feet 

Heart and Circulation 

Respiration. 

Nose throat lungs 

Digestion 

General Condition 

Abnormalities 

Remarks 



GENERAL DIRECTIONS FOR TAKING MEASUREMENTS. 

Inasmuch as the value of these measurements, both to 
the individual and to science, will largely depend on the accuracy 
with which they are taken and since there can be no real com- 
parison between the results of different observers unless ab- 
solute uniformity of method is adhered to, the following direc- 
tions are first given : 

Each examiner is advised to review at least once a year 
the directions for taking the measurements and tests, to be 
sure he has not departed from the standard. 

The use of the metric system of weights and measures, 
justified by its history among the scientists of the world, is 
advised for its accuracy, ease and its world-wide acceptance. 
Linear measurements should be recorded in millimeters, cen- 
timeters are too inaccurate, weighs in kilos and tenths, capacity 
in liters and hundredths. 



46 



What to Measure and How to Measure. 



If it is impracticable to use the metric system, inches and 
tenths may be used for linear measures, pounds and tenths 
for weights and cubic inches for capacities. 

For accuracy in individual comparisions it is best to take 
later measurements of an individual at the same hour of the 
day as that of his first. 

In taking the girths the tape should be pulled sufficiently 
tight to adapt it as far as possible to the body surface, this 
tension is about one pound and may be measured by the spring 
tape devised by Dr. Gulick. 

It is important to remember that girths should be taken 
at right angles to the long axis of the part measured. 

The most satisfactory tapes of cloth, inextensile and about 10 
mm. wide. They should be 1,500 mm. long (about 5 ft.) gradu- 
ated to mm. on one side and inches and tenths on the other. 

Proper hygiene conditions should be observed with all 
instruments used. Mouth pieces should be sterilized in three 
per cent, carbolic or other antiseptic solution before each use. 
They should be frequently cleaned. Tapes should be frequently 
renewed or cleaned. 

MINIMUM LIST RECOMMENDED FOR COLLEGES, SECONDARY SCHOOLS, 
YOUNG MEN'S CHRISTIAN ASSOCIATIONS, ETC. 



Height. 

Weight. 

Body length (episternal) . 

Girth of Neck. 

Girth of Lower Chest Expanded 

(9th Rib). 
Girth of Lower Chest Contracted 
Girth of Waist. 
Girth of Right Thigh. 
Girth of Left Thigh. 
Girth of Right Calf. 
Girth of Left Calf. 



Girth of Right Upper Arm, up. 
Girth of Left Upper Arm, up. 
Girth of Right Forearm. 
Girth of Left Forearm. 
Girth of Right Wrist. 
Breadth of Shoulders. 
Breadth of Chest, normal. 
Breadth of Waist. 
Breadth of Hips. 
Depth of Chest, normal. 
Depth of Abdomen. 



Capacity of Lungs. 

STRENGTH TESTS. 

Strength of Biceps (Pull up) . 
Strength of Right Forearm. 
Strength of Triceps (Push up) . Strength of Left Forearm. 

MINIMUM LIST RECOMMENDED FOR PUBLIC SCHOOLS. 



Strength of Back. 
Strength of Legs. 



Weight. 
Height. 
Sitting height. 
Girth of Neck. 

Girth of Chest Expanded (at 
Nipples) . 



Girth of Chest Contracted (at 

Nipples) . 
Breadth of Shoulders. 
Breadth of Chest, normal. 
Breadth of Waist. 
Depth of Chest, normal. 
Lung Capacity. 



What to Measure and How to Measure. 47 

Age. Record years and months, as: 21, 9, i. e., twenty- 
one years and nine months; and also birthday, as: Aug. 4, 
1884. To be doubly sure regarding this important item, 
ask the examined how old he or she is and also the date of 
birth (year, month and day) . 

Height. The height should be taken without shoes and 
with the head uncovered. The weight should rest squarely 
on both feet. The head and figure should be held rigidly 
erect, eyes to the front, and the heels together. This posi- 
tion is best secured by bringing the heels, buttocks, the spine 
between the shoulders, and the back of the head, in contact 
with the measuring rod. 

Weight. The weight of the body should be taken without 
clothes. Where this is impracticable, the weight of the clothes 
should be deducted. 

Body Length (Episternal). Let the subject sit on a hard 
flat surface about 15 inches high, such as is afforded by a box or 
chair, with the head and body rigidly erect. Measure the per- 
pendicular distance from the box to the interclavicular notch. 

Girth of Neck. With the head of the subject erect, pass the 
tape around the neck half way between the head and body 
or just below the "Adam's apple." 

Girth of Lower Chest (pth Rib), Contracted and Expanded. 
These measurements are taken over the ninth rib where it 
crosses the mamary line. Pass the tape around the chest 
midway between the lower border of the large pectoral muscle 
and the lowest free rib. Take the first measurement after 
a full inspiration and the second after a full expiration. 

Girth of Waist. The waist should be measured at the 
smallest part midway between the twelfth rib and the crest of 
ilium, after a natural inspiration. 

Girth of Right and Left Thighs. With the feet of the sub- 
ject about six inches apart, the muscles set just enough to 
maintain the equilibrium of the body and the weight dis- 
tributed equally to each leg, measure around the thigh in 
gluteal fold, just below the nates at right angles to the long 
axis of femur. 

Girth of Right and Left Calves. With the heels down and 
the weight of the body supported equally on both feet, meas- 
ure around the largest part of the calf. 

Girth of Upper Right and Left Arms, Contracted. With the 
arm of the subject flexed at the elbow, palm of hand toward 
the shoulder, firmly contracting the biceps, and held away 
from the body in a horizontal position, pass the tape around 
the greatest prominence at right angles to long axis of humerus. 
^ Girth of Right and Left Forearms. With fingers of subject 
tightly clinched, measure around the largest part, just below 
elbow. 



48 



What to Measure and How to Measure. 



Girth of Right Wrist. With the hand of the subject open 
and the muscles of the forearm relaxed, measure between the 
styloid process and the hand. 

Breadth of Shoulders. With the subject standing with 
arms at sides as in position of "attention," shoulders neither 
dropped forward nor braced backward, measure the broadest 
part two inches below the acromion processes. 

Breadth of Chest, Normal. Measure with breadth calipers 
between the axillae at the level of the nipples (or fourth rib) 
after a natural inspiration. 

Breadth of Waist. Measure at the narrowest part mid- 
way between the twelfth rib and the crest of the ilia. 

Breadth of Hips. Measure at the widest part over the 
trochanters. 

Depth of Chest. Taken after natural inspiration. Place 

one foot of the calipers 
on the sternum midway 
between the nipples, and 
the other foot on the spine 
at such point that the line 
of measurement is at right 
angles with the axis of 
the spinal column. 

Depth of Abdomen. 
Place one foot of the 
calipers immediately 
above the navel, the other 
on the spine at such a 
point that the line of 
measurement is at right 
angles to the axis of the 
spinal column. 

Strength of Back. The 
apparatus used for this test 
is a spring dynamometer of a capacity of 900 kilos. This must 
not be attached to an eyebolt or staple directly to the floor 
or a table or platform as formerly (prior to December 30, 1903), 
but it must be attached to a movable wooden foot-rest of the 
following dimensions (Fig. 33) : A wooden plank 20 inches 
long, 12 inches wide and 1J^ inches thick. Mortised into this 
plank should be a boxed framework made out of 1-inch hard- wood 
stock 9 inches high, 5 inches wide and 4 inches deep. This 
box should be placed near the longitudinal center of the plank, 
with the front edge of the box two inches from the front edge of 
the plank, and the box should have a slot cut in the top and bottom 
large enough to allow the ends of the dynamometer to be in- 
serted for support and protection. The dynamometer should 
be fastened on the under side of the plank with a 6-inch -^ steel 




Fig. 33. 



What to Measure and How to Measure. 



49 



bolt fastened with screws. The top of the box frame should also 
be fastened with screws so that it could be removed if necessary 
in order to release the dyna- 
mometer. A steel chain 18 
inches long of T 5 g- inch wire ^t ^m^m/^ mml^lsm 
and 13^2 inch links should be 
attached to the top of the 
dynamometer by a screw eye- 
bolt. The handle used must 
be at least 1 inch and not 
more than l^ inches in dia- 
meter and not over 12 inches 
long. The steel hook attached 
to the handle should be made 
out of 3^2-inch steel and not more 
than 3 inches long. (Fig. 34). 

Directions for Back-Lift. 
Stand upon the movable foot- 
rest in order to hold it down 
to the floor with the weight of 
the body while lifting. ' Neither 
the foot-rest nor the dyna- 
mometer must ever be fastened 
to the floor by screws, nails 
or any device whatever. Ad- 
just the handle to the chain so 
that when standing erect the 
outstretched fingers placed in 
front of the thighs will come within about three inches of the 
handle. Incline the body forward at an angle of about 60° 
(viz., 30° from the perpendicular), grasp the handle, take a 
full breath, and without bending the knees, give one hard, 
steady lift, mostly with the back. No swaying of the body 
backward or forward, or throwing the weight on to the handle 
will be allowed. 

Strength of Legs. With the same apparatus arranged as 
for the back-lift, standing upon the foot-rest with the body 
and head erect, chest thrown forward, and bending the knees 
until the handle, grasped with both hands, rests against the 
thighs, take a full breath, and give one hard, steady lift, mostly 
with the legs, using the hands to hold the handle in place. 
Lifts made by "snapping," "jerking" or "jumping" up the 
dynamometer, will not be accepted. 

The Forearm Test. The apparatus used for this test is an 
oval-shaped spring dynamometer of a capacity of 110 kilos. 

Directions for Testing the Forearms. Holding the dyna- 
mometer squarely in the hand, with the dial turned inward, 
squeeze the spring as hard as possible: note the squeeze of the 
right hand, and then the squeeze of the left hand taken the 




Fig. 34. 



50 What to Measure and How to Measure. 

same way. In making this test the individual must be cau- 
tioned against touching any part of the person or any object 
whatever with the arm or hand holding the dynamometer. 

Capacity of Lungs. This test is made with a wet spiro- 
meter with a capacity of 400 cubic inches (6 . 56 litres) . 

Directions. Fill the lungs to their utmost capacity and 
blow slowly into the spirometer, finishing the effort with a 
little spurt. Note the highest figures which appear on the 
rising tube. 

As there is some objection to the use of the manometer 
for the "strength of lungs" test, it has been decided to accept 
-fo of the lung capacity in centilitres as a fair equivalent of 
the former. This will enable those institutions having the 
two instruments to allow their pupils an option as to which 
one they will have reckoned in the total strength test, and 
allow those institutions using only the spirometer to enter 
these tests on terms that will make them comparable with 
those which have been made for years with the manometer. 

The Strength of Upper- Arms {Triceps) and Chest. The 
apparatus for making this test are parallel bars, which must 
stand at least five (5) feet from the floor and be eighteen (18) 
inches apart, inside measurement. Eighteen inches from the 
end of the bars there must be a screen or partition 18 inches 
wide and about 30 inches high erected vertically, and a cord 
or tape must be stretched between two pegs at a height of 3 
inches above the level of the top of the bars. 

Directions. After taking a position of rest upon the 
parallel bars, supporting the weight with the arms straight, 
let the body down until the chin touches the cord or tape sus- 
pended between the bars, then raise the body until the arms 
are fully extended. Count the number of times the body is 
raised from the first time the chin touches the cord. In making 
this test the legs must be kept straight and as nearly as possible 
on a line with the trunk. 

Strength of Upper- Arms {Biceps) and Back. The apparatus 
used for making this test is a horizontal bar not less than 1 
inch or more than 1^ inches in diameter, suspended 8 feet 
from the floor. 

Directions. Take hold of the horizontal bar with ordinary 
or reversed grasp and hang with arms and legs extended at 
full reach. From this position raise the body until the chin 
is level with the top of the bar and return to the extended position. 
Count the number of times which the body is so raised from 
this position. In both the parallel and the horizontal bar 
tests the legs must be kept straight and the examiner should 
check the tendency to swing or any other form of vibration. 

(In case the individual is not able to raise his weight once 
on the parallel or horizontal bars, or where the total strength 



What to Measure and How to Measure. 51 

of women is to be compared with men, tests No. 2 and 3 from 
Dr. Sargent's Universal Test for Strength, Speed and Endu- 
rance may be substituted for the ordinary "dipping" and 
"chinning." In this case only ^\ instead of -fa of the 
weight is multiplied into the number of "dips" and "chins" in 
computing the strength of arms-chest and arms-back.) 

Total Strength. The points that make up the total 
strength are reckoned as follows: The number of kilos lifted 
with the back bent and the number of kilos lifted with the 
legs bent, added to the strength of the grip of the right and 
left hands, and yV of the weight in kilos multiplied by the 
number of times the person can raise his weight by dipping 
between the parallel bars and pulling his weight up to his chin 
on the horizontal bar as previously described, plus -fa of 
the lung capacity in centilitres; or, 

(D-hP)xW L. C. 

T. S.=B+L + 2F+ - — —t^ + 



10 ' 20 

DIRECTIONS FOR TAKING THOSE MEASUREMENTS RECOMMENDED 
FOR THE PUBLIC SCHOOLS WHICH ARE NOT IN THE LARGER 
MINIMUM LIST. 

Sitting Height. Let the subject sit on a hard, flat surface 
about 15 inches high, such as is afforded by a box or chair, 
with the head and body rigidly erect so that the body at the 
buttocks, between the shoulders, and at the back of the head, 
shall touch the measuring rod. Measure the distance from the 
box to the vertex. 

Girth of Chest, Expanded and Contracted. Pass the tape 
around the chest so that it shall embrace the scapulae and 
cover the nipples and lie at right angles to the long axis of 
the chest. Measure girth after a complete inspiration and 
after a complete expiration. 

Breadth of Head. Measure with breadth calipers at the 
broadest part of the level of the tops of the ears. 

Length of Head. Measure with breadth calipers the 
greatest length between the median line of the forehead and 
occipital bone at its upper prominent part. 

The following criticisms of this Report, that now stands as 
the official list of the Association, are presented: 

In taking the Girth of Lower Chest the directions are not 
sufficiently specific, for the tape may be lying in any plane 
and there is some doubt as to whether the ninth rib crosses 
the mammary line in all cases, as this line is determined by a 
perpendicular let fall from the nipple. 

It would seem advisable to direct that the tape should 



52 What to Measure and How to Measure. 

bear some relation to the lower angles of the scapulae on the 
posterior aspect of the chest and to the lower borders of the 
pectoral muscles or to the nipples in front. If the tape be 
placed on the chest so that it will lie two or three centimeters 
below the lower angles of the scapulae and five to six centi- 
meters below the horizontal line of the nipples it would seem 
to include the most movable part of the chest. This position 
could be named from the ensiform cartilage that will usually 
be included by the tape. The position of the ninth rib is lower 
than is usually supposed and from its oblique position does 
not give any definite landmark. The position suggested here 
is undoubtedly higher than is intended in the official direc- 
tions. 

In the directions for taking Strength of Back there is some 
confusion because of the failure to have a single definite state- 
ment of the method without the use of complicating terms. 
No person has a clear idea of degrees as units of measure. If 
the handle be so placed that it is "three inches" below the 
finger tips as the person stands erect there will be no question 
as to the angle of the body when the handle is grasped, if the 
knees be kept in complete extension. It would seem that em- 
phasis should be placed on the position of the knees and that 
the handle should not be allowed to touch the thighs during 
the effort. 

In the test of Strength of Upper-arms and Chest there is 
no restriction in the use of the neck to drop the head forward 
until the chin touches the cord and thus relieve the arms of 
the necessity of taking a position of complete flexion. The 
rule should cover this point as well as that of extension. 

In taking strength of arms, chest and back by these move- 
ments of "dipping" and "chinning," as they are commonly 
called, we do not use the same kind of a test that is employed 
in the leg lift, grip of hand, etc., where the muscles are re- 
quired to contract to their greatest ability for a single time 
and the force of the movement is recorded, but we make it a 
test of working endurance where the load carried is essentially 
the maximum under which the muscles can contract. It 
would therefore seem to be more fair to reduce the test to 
terms of actual work done so that any perversion of the method 
could not add to the record obtained. This can easily be done 
by an instrument devised by Dr. W. G. Anderson of the Yale 



What to Measure and How to Measure. 53 

Gymnasium and consisting of a lever some two meters long 
and having one end attached to the waist of the subject by a 
belt, while the other is made to carry a pencil that marks on a 
moving paper the reduced excursion of the long arm that is 
attached to the waist. The number and extent of the eleva- 
tions of the body can thus be definitely measured and the 
total amount of elevation of the weight be computed. 

The computation of "total strength" includes the inconsis- 
tent record of lung capacity that probably bears no direct 
relation to strength. What is more surprising is that this is 
permitted as a substitution for "Strength of Lungs" or expi- 
ratory pressure that has been taken by blowing into a pressure 
guage. The intent of this test was originally to discover the 
power of the expiratory muscles but a difficulty has been found 
in eliminating the influence of the buccal muscles that are 
much stronger than the expiratory groups; so that when a 
person is asked to blow as hard as he can into the apparatus, 
and keep the throat open, as in respiration, he will involuntarily 
close the pharynx with the back of the tongue and palate, 
and then bring the muscles of the cheeks and lips into active 
contraction, and, with a few efforts, acquire such skill as to 
rival the cornet player in the record secured. 

This test should be dropped from the strength records 
altogether, for by so doing the scientific value of the data is 
improved and the value of past records in comparisons is not 
impaired. 

The breadth of shoulders should be a bone measurement as 
nearly as possible; for I conceive the object of it to be the 
determination of the extent of the bone tissue to which the 
more important muscles of the upper extremities and thorax 
are attached. If we measure below the acromion, as directed, 
we give a person credit for broad shoulders simply because he 
has a thick deltoid muscle and the muscles of the chest and arm 
add to the record, in such cases, by making the arm hang at 
an angle instead of perpendicularly, as expected. 

The length of trunk, depth of chest and breadth of chest 
are three factors, that, multiplied together, may roughly be 
considered to represent the "vital capacity" of a person. We 
can get the length of trunk in another way — by substracting the 
height of sternum from total height, which will give the length 
of head and neck; and, by substracting this remainder from the 



54 What to Measure and How to Measure. 

height sitting we shall have the length of trunk. If the height 
of knee is to be measured, the most convenient landmark is to 
top of the fibula, as the subject is sitting. 

For those who are making a special study of athletes a 
measurement suggested by Dr. Savage of New York is worthy 
of notice, namely, the length of the os calcis, this being the lever 
arm of the muscles that extend the foot; its relation to the 
metatarsal and phalangeal portion is doubtless of importance 
in determining the ability for such exercises as running, walking 
jumping, etc. 

Dr. Mosher thinks that depth of chest should be a double 
measurement, showing thickness of right and left chest, and 
the suggestion is a good one, because in many cases the sternum 
is depressed and the record, if made strictly by rule, would be 
smaller than the subject deserves, and this method would show 
any asymmetry of the chest. 

Some points in minute anthropometry have been suggested 
by various specialists, but obviously such work should be left 
to those who wish to study some particular phase of the subject, 
The height of ear, girth of ankles and hands, depth of pelvis, 
neck and head, length of hands, fingers, ears, etc., have all 
been recorded by some observers. 

The French police regulations require a minute measure- 
ment of the ear and middle finger for identification of criminals 
if they are arrested a second time. These measures help in 
classifying the photographs that are taken so that they can be 
readily found among thousands. 

Some form of anthropometrical tests can no doubt be made 
more serviceable in establishing identity in a "rogues' gallery" 
than photography. The physiological picture of a man as 
shown on a graphic chart is sure to retain some characteristic 
feature, whatever may be his condition. The imprint of the 
papillary ridges of the thumbs has been shown by Galton to be 
an efficient means of identification. 

Photography may be wisely used as an adjunct of anthro- 
pometry. Since Prof. Muybridge made his wonderful pictures 
of animal locomotion by instantaneous process the value of a 
photograph to show physical deficiencies as well as excellence 
has been established. It makes a record in an artistic way that 
is made by tape and calipers in a mathematical or scientific way. 
Already at some of the better equipped gymnasiums photog- 



What to Measure and How to Measure. 



DO 



raphy is made to assist in preserving the record of a man's 
physical condition. 

It is well to have all instruments kept in a cabinet where 
they will not be handled except when in use, as they are liable 
to get soiled and injured so that they work poorly or inac- 
curately. A simple case for this purpose is shown in Fig. 
35. All instruments should be 
tested for accuracy frequently 
and the less they are handled 
by those who do not under- 
stand their use the more pre- 
cise will be their readings with- 
out adjustments. 

The tests for accuracy and 
strength may be made by a 
series of athletic exercises and 
show something of the nerve 
training that the subject has 
had — in other words, the self- 
controlled power. In a person 
we may test the strength of fifty 
groups of muscles acting sepa- 
rately so far as possible and, 
while our record may be high, 
we may still have a very inade- 
quate estimate of the co-ordina- 
ted power — the real strength of 
the individual, which may be 
small. Probably the best ex- 
hibit of a man's power is seen in 
such games as football, where 
the strength of every muscle is 
tested both as to its own quality 

and its adjustment to other muscular groups and to mental 
stimuli. 

Another refinement of anthropometry is taking the spe- 
cific gravity of a man. This may not be a feasible addition to 
practical anthropometry but for minute study may afford an 
interesting field of investigation. The record can be taken by 
immersing the subject to the face or any suitable point in a 
reservoir of water that is situated on a scale for weighing. 




Fig. 35. 



56 What to Measure and How to Measure. 

From the weights of the reservoir full of water, the displaced 
water and the immersed subject in the reservoir the specific 
gravity has been calculated. The fact has been often noted 
that men of small girths often show a weight far above what 
would be fairly estimated, but as yet there has been no scien- 
tific study of this class of cases to discover the relation of high 
specific gravity to health, strength, endurance or longevity. 
The specific gravity of any body is represented by the quotient 
obtained by dividing the weight of the body in air by the loss 
of weight when weighed in water. 

The discovery of the superficial area of a person is of some 
value and may be found by the following formula: Surface, 
(in square centimeters) = 1 1 X s V Weight 2 , (in grams) . 



Personal History and Examination of the Special Senses. 57 



CHAPTER IV. 



PERSONAL HISTORY AND EXAMINATION OF THE SPECIAL SENSES. 

In examining young people the condition of the organs of 
special sense becomes a legitimate and important field of in- 
quiry and record. Civilized man is as much the product of 
nerve reactions as he is the result of material influences that 
we ordinarily call hygiene — food, air, temperature, etc. The 
intellectual working of the brain is, in fact., more strongly in- 
fluenced by defective sense impressions than it is by defective 
nutrition. The tinnitus of a diseased ear has driven many a 
person insane, and the nerve strain of an imperfect eye has pro- 
duced the most serious functional disease of the nervous system.* 

The eyes should be examined by a specialist in ophthal- 
mology if there is the slighest indication of nerve irritation 
and the superficial examination such as is indicated here, 
shows the slightest error of refraction or muscular insuffi- 
ciency. 

The record of color-blindness should be kept, not as a 
disease, but as a peculiarity that would render the subject 
unfit for some occupations. In many cases of supposed color- 
blindness the sense is probably simply uneducated. Cases of 
color-blindness among women are very rare (1 in 25,000) and 
are not frequent among men. 

Among school children and adults who are engaged in 
sedentary occupations requiring the almost constant use of 
the eye it becomes absolutely necessary that the visual organ 
be essentially perfect if the brain is to work with its maximum 
of power for a long period. That the examination of the eye 

*See the New York Medical Journal for January 7 and 14, 1888, and 
the same journal February 27 and March 13, 1886, containing articles by 
A. L. Ranney, M". D.. on "The Treatment of Functional Nervous Diseases 
by the Relief of Eye-Strain," etc. Also the Belgian Prize Essay by Dr. 
Stevens of New York, and the Report of the Stevens Commission pub- 
lished in the Neurological Journal, 1889. See article by Dr. Gould in 
American Medicine, January 21, 1905, and Journal of American Medical 
Association, 1904. 



58 Personal History and Examination of the Special Senses. 

is important is proved by the number of cases of error of re- 
fraction to be found in any group and the very complete remedy 
that is found in properly adjusted lenses. 

Dr. Seelye has found that only about twenty-seven per 
cent, of the students have normal vision. The following table 
shows the variety and prevalence of errors by percentages: 

Emmetropia. Hyperopia. Myopia. Astigmatism. 

Amherst 27 44 23 22 

Yale 42 23 19 35 

New York University 57 14 29 — 

The difference in these results is largely due to the standard 
of working. In the figures from Amherst the greatest accuracy 
exists, as all the tests were made by a trained specialist in oph- 
thalmology. 

A few brief definitions of terms used may be of assistance 
in understanding the table. By Emmetropia is meant normal 
or perfect vision. All rays of light coming from a distant ob- 
ject focus or meet at one point exactly upon the retina and form 
a clear image there. 

Myopia or "near-sightedness" is due to the eye being so 
long in the antero-posterior diameter that rays of light which 
enter the eye parallel or from a distance come to a focus a 
little in front of the retina and hence an indistinct image is form- 
ed on the retina. 

In Hypermetropia or 'far-sightedness" the eye is too short 
in the antero-posterior diameter, and hence parallel rays en- 
tering the eye focus behind the retina, and thus the image made 
on the retina is a blurred one. 

In Astigmatism the anterior part of the eye is irregular 
in curvature, and therefore rays of light entering in the differ- 
ent diameters focus at irregular distances on, in front of, 
or behind the retina, so that the image of the object seen is 
distorted. That is, all rays do not focus or meet at the same 
point. 

The following directions are given for testing the refrac- 
tive power of the eye and its color sense and also for deter- 
mining the auditory power: 

Procure from any optician the "pocket-test case" made by 
the Julius King Optical Co., of New York City, or two pairs 
of spectacles, one with convex glasses, No. + .75 Dioptric 
(equal to No. + 48 in the old or English system) , and the other with 



Personal History and Examination of the Special Senses. 59 

concave glasses, No. — .75 Dioptric. Also obtain a copy of 
Snellen's test letters of any optician, to be hung up at six meters 
distance, and a copy of Green's astigmatic lines, in the form of 
a clock face, to be hung up at the same distance. 

Test. Seat the subject at a distance of six meters (20 feet) 
from the test cards, which should be hung in a good light. 
Examine each eye separately, keeping the other covered by a 
card held in front of, but not touching it, or use the blank of 
the test case. Never press the fingers against the closed lid. 

There are a number of lines of letters on the test card, 
numbered from 4 to 60 meters, which indicates the distance 
the letters can be read by the normal eye. If, now, the sub- 
ject can read the next to the smallest letters on the card, with 
the right eye (R. E.) alone, his vision (V.) is recorded as f 
or 1. (V. R. E. = l.) If he sees nothing clearly above the 
eight meter line from the bottom, but can read that correctly, 
then V. R. E. = |. If he cannot read any of the lines, then 
V. R. E. is less than ^\, and is recorded as follows : V. R. E. <^ -g^. 
Whatever the vision without glasses may prove to be, always 
next put on the convex spectacles and again cover the other eye. 
If now he can still with the right eye see as well or better than 
with no glasses at all, and can read the same line as before, he 
is Hypermetropic (H.) in that eye (i. e., far-sighted). For 
example, if without glasses it was found the V. R. E. = T 6 ¥ , and 
now after adding the convex glass, his V. is improved to f , the 
record would be V. R. E.= t 6 q +H.= -|. But if the vision is 
neither improved nor made worse by the convex glass, the 
record will be thus: V. R. E. = § -f H. = -f. If the convex 
glass can be used at all without decreasing the vision, no further 
testing with this card is needed; the subject is hypermetropic 
in that eye. If it is found that the vision of the right eye equals 
1, without glasses, and then the addition of the convex glasses 
blurs the letters, the eye is Emmetropic (Em.) — that is, there 
is no error of refraction. 

If, however, the vision without the glasses is less than 1., 
for instance only -§-, and the convex glasses make even that 
line more indistinct, then put on the concave glasses. If now 
the vision is improved so that smaller line can be read, the 
eye is Myopic, or "near-sighted," and the record will be V. R. E. 
= -| -f- M. = f. Or again, if the vision without glasses in the 
left eye is found to be -/q-, and then with the concave glasses 



60 Personal History and Examination of the Special Senses. 

the ten meter line can be read, the record will stand thus : V. L. 
E. = ^-g- 4- M. = T V After testing each eye separately, place 
the record of one above the other, for example, thus: 

jV. R. E. = l.Em. 
1V.L.E. = JH-M. = * 

This completes the testing for simple hypermetropia, 
myopia and emmet ropia. 

After testing the eyes as above, if the vision has not yet 
been found perfect in either, leave on the proper correcting 
glass, the convex if there is hypermetropia, or the concave 
if there is myopia, or use no glass if there is neither; then direct 
the subject's attention with one eye alone, the other being cover- 
ed, to the card of radiating black lines. If he sees one or more 
of the lines running in any direction clearer or blacker than 
those at right angles to them, the eye is shown to be astigmatic. 
Either the perpendicular or the horizontal lines usually appear 
the blacker to the astigmatic person. If the previous record 
was V. R. E. — f, and this defect is found, then it will be V. R. 
E. = f + A. Or if before it read V. L. E. = T V+ M. = -§, and 
astigmatism is found, it will read, V. L. E. = T 6 ¥ +M. =-§■+ A. 
Astigmatism may exist either alone or in combination with 
M. cr H. If alone we might have a record thus: V. R. E. 
= -§■+ A. ; V. L. E. = j 6 g-+ A., or if with hypermetropia, thus: 
V. R. E.= T HH.=| + A.; V. L. E.=A + H.=* + A. 

To recapitulate, in brief: if it is found that V. R. E. = 1, 
then the R. E. is Emmetropic or Hypermetropic. If Emme- 
tropic, the convex glass will markedly impair the vision; if 
hypermetropic it will not. If the V. R. E. = -§- or less, then 
the R. E. is either hypermetropic, myopic, astigmatic or am- 
blyopic. 

1st. If it is H. the convex glass will help, or not greatly 
impair the vision. 

2d. If it is M. the concave glass will improve V. 

3rd. If it is A. one of the radiating lines is blackest. 

4th. If neither of these defects exist and the V. is less 
than T 6 o-, then Amblyopia or partial blindness may be recorded. 
It may read thus: V. L. E. =xo + Am. 

Caution — Always try the convex glass. Never try the 
concave unless the convex glass blurs the vision. Have subject 
close the eyes when not being tested. 



Personal History cuid Examination of the Special Senses. 61 

In addition to the text of vision for distinctness at dis- 
tances, it is well to test the power of the eye at near points. 
To do this is a very simple matter and requires only a card 
printed with Jaeger's test-type of sizes from Xo. 1 to 5 in- 
clusive. The size of No. 1 is that commonly known to printers 
as "Gem" or "Brilliant," and the other numbers are the succes- 
sive sizes of type larger than this. The cards can be obtained 
at any optician's. In using the card, the main point is to dis- 
cover the ability of the person to read near print and thus show 
the power of accommodation, and hypermetropia, for the far- 
sighted eye cannot see objects clearly at near range. The person 
being examined should take the card and try to read the various 
paragraphs as near to the eye as possible, each eye being tested 
by itself as before, and the examiner, with a tape or ruler, meas- 
ures the distance at which the card is held from the eye. This 
may then be recorded as follows: Xear point of right eye equals 
Jaeger's No. 1 at 25 c. m. — or whatever the record may be. 
This may be abbreviated as follows: N. P. R. E. = J. No. 1, 
25 c. m. A record of 25 c. m. for this size of type would be 
very good and in most cases of hypermetropia the larger type 
will have to be used. The record then might be as follows: 
X. P. R. E. = J. No. 3, 15 c. m. 

In the following cases the subject should be recommended 
to consult an oculist concerning the advisability of wearing 
glasses: (a) if the vision without any glasses is less than^ 
in either or both eyes; (b) if he complains of weak, watery or 
painful eyes, headache, especially in reading, and any degree 
of hypermetropia or astigmatism is found to exist ; (c) if the 
eyes are unlike to the extent of two lines on the test card. 

DIRECTIONS FOR TESTING THE COLOR SENSE. 

A set of test worsteds of different primary colors and 
shades may be procured. To make the examination, spread 
all the worsteds out on a white cloth placed upon a table. 
First lay the green test skein a little to one side of the others, 
and then tell the subject to throw out of the pile and la)' along- 
side of the test skein, all the lighter and darker shades of that 
color, or all the skeins containing a shade of that color in 
any degree. Avoid naming the color "green" to him. If he 
throws out only shades of green or light blues his color sense is 



62 Personal History and Examination of the Special Senses. 

normal (C. S. N. )and the test is completed. But, if in addition, 
he throws out light grays, or any other shade of gray, or light 
yellows, salmons, or pinks, he is color-blind. If he handles 
or fumbles over those shades a good deal and hesitates, 
as if in doubt about them, but yet does not throw them out, he 
probably has "feeble color sense" (C. S. F.). The examiner 
in these cases must use his judgment in making a certain 
amount of allowance for the stupidity of some persons in under- 
standing what is wanted, especially in the young and unedu- 
cated. 

If the subject is found to be color-blind, next lay down 
the purple or rose-colored test skein, in place of the green, in 
order to determine the nature of the defect. Now tell him 
to throw out all the different shades of that color. If he only 
throws out pinks and light reds and shades approaching these, 
he is only partly color blind (P. C. B.). But if he throws out 
decidedly bluish purples, blues, violets, greens or grays, he 
is completely color-blind (C. C. B.). Completely red-blind 
if he throws out the blues, violets, etc., or green-blind if the grays 
or greens. 

No further testing is needed, but as a matter of curiosity, 
and to prove the result, the red test skein may next be tried 
in the same way. If he matches with it browns or greens and 
grays he is completely color-blind. Dark brown or green if 
red-blind, and light brown or green if green-blind. 

It is important to record whether the complete color- 
blindness is red or green blindness. The following classes 
may be recorded: Color sense normal = C. S. N. ; Color sense 
feeble = C. S. F. ; Partial color-blindness = P. C. B.; Complete 
color-blindness = C. C. B. 

Color-blind individuals should be warned against engag- 
ing in any occupation where this defect would prove dan- 
gerous or inconvenient. 

DIRECTIONS FOR TESTING THE AUDITORY SENSE. 

Use any ordinary watch and a tuning-fork, letter A or C, 
as tests. Seat the subject with his right side toward you and 
then, while the room is perfectly quiet, see how far off he can 
hear the watch tick. Having previously learned by a few 



Personal History and Examination of the Special Senses. 63 

experiments what is the furthest distance at which the tick 
can be heard by normal ears, make that number of inches 
the denominator of a fraction, and the hearing distance of 
each person examined thereafter the numerator. Having 
found the normal distance (=H. D.) to be, for instance, about 
sixty inches, and that of the subject now examined to be, say 
forty inches, his record for the right ear would then be: H. D. 
R. E. — -f-jj-. If it had been -f-jj- or 1, the ear would be normal. 
-§-§- would show an abnormally acute sense of hearing. If the 
watch could only be heard while in contact with his ear, it would 
be recorded: H. D. R. E. =-^o- If n0 "t heard at all, then 
H. D. R. E. = -g°Q-. Next test the left ear in the same way. 
Voice sounds in talking will often be easily heard by persons 
quite deaf to the watch tick, so that the latter is not always 
a reliable practical test. 

Suppose we have found H. D. R. E. = ££ , H. D. L. E. = 1, 
this implies some deafness in the right ear, and the tuning-fork 
will now help us to decide whether the cause lies in some de- 
fect of the auditory nerve or internal ear, or in the external 
or middle ear or Eustachian tube. Strike the fork against 
some solid substance, and then place the end of the handle 
against or between the subject's front teeth. If both ears 
are normal he will probably seem to hear the ringing of the 
fork equally well in both ears. But if there is a defect in one 
ear he will either seem to hear it louder or more feebly in the 
affected ear. If, as in the case we are examining, the fork 
is heard best in the deaf ear, this tells us that the deafness 
is due to some defect in the more external parts of the organ, 
and it can probably be corrected by appropriate treatment. 
But if it is heard best in the good ear, it goes to prove that the 
defect in the other ear is more deeply seated and cannot prob- 
ably be greatly benefited by treatment. This effect of the 
tuning-fork is contrary to what would ordinarily be expected, 
and it is often a matter of surprise to a deaf person to find that 
he hears with his teeth apparently better on the deaf side. 

We may now add to our record in this case: T. F. best 
R. E. If it had been heard equally well in both ears we would 
read: T. F. = N. (or normal). Where the defect in hearing 
is at all marked, a specialist in ear diseases should be consulted. 

Our record in a normal case might be thus : H. D. R. E. = 1 , 
H. D. L. E. = 1, T. F. = N.; or in an abnormal case it might be 



64 Personal History and Examination of the Special Senses. 

thus: H. D. R. E. = 1, H. D. L. E.=^- , T. F. best in R. E. 
This would imply that the subject was so deaf in the left ear as 
not to be able to hear the watch tick at all, and the fork held 
between the teeth could be heard best in the good ear, conse- 
quently his trouble is probably seated in the deeper struc- 
tures of the ear, or in the nerve itself, and treatment would 
not be expected to help him greatly. The tuning-fork need 
not be tried unless the watch tick shows some defect in hearing. 
When tests of the hearing are made, any dullness or differ- 
ence in the auditory sense of the two ears should lead to an 
examination with the otoscope. The channel may be partially 
or completely occluded with wax or the debris of a previous 
inflammation or an exostosis of the wall of the meatus. 
If the opening is normal, the tympanum, or membrane will 
be seen at a depth of about two centimeters as a smooth, shin- 
ing, semi-transparent membrane of slightly pinkish-gray color. 
In cases of inflammation the drum becomes decidedly pink. 
Slightly below and in front of the center is a white spot as though 
some white body pressed the drum slightly forward at that 
point. This' is the end of the bone, the malleus, that conveys 
the vibrations back to the internal ear. In most cases a gray 
streak can be seen extending upward and forward, which is 
the body of the bone. Sometimes the drum will appear bulg- 
ing and convex, from the pressure of serum within, and the 
vibrations of the drum are prevented, with resulting deafness. 
Again the drum may appear cupped or concave from the stoppage 
of the eustachian tube and the subsequent absorption of air in the 
middle ear, so that the drum is pushed in by the atmospheric 
pressure. This is by far the more common condition and 
only impairment of hearing results until the case is of long 
standing, when complete deafness may ensue. Openings in 
the drum are of frequent occurrence as the result of inflam- 
matory exudation bursting through from the inside, or trau- 
matic puncture that has been uncared for. A puncture may 
not impair the hearing to any serious extent. Suppuration 
of the ear in any part should be the subject of surgical treat- 
ment at once, without regard to the whims or prejudices of 
the persons possessing an otorrhoea. The discharge is often 
looked upon as a necessary affliction and relief from other 
woes, but in reality it is a source of debility and impairment 
of health to the person himself, and a nuisance to others. Cases 



Personal History and Examination of the Special Senses. 65 

of impaction require treatment, and the same may be said of 
the convex drum. The convex drum may be due to catarrh, 
and if so, that should be treated. All these cases are to be 
referred to physicians. 

An organ may work correctly but slowly. The eye of one 
person sees at a glance what the eye of a second person would 
require seconds to reveal, and yet the eye of the latter may 
be perfect according to every test of the oculist. It is so with 
hearing. The time required between hearing and perceiving 
sounds and giving a signal is . 12 to . 18 of a second. Higher 
tones require slightly less time than deeper ones. Noises are 
heard quickest. 

A distinguished teacher recently told me that he had 
called a certain boy stupid until he discovered that the boy 
was merely slow in his sense of hearing. Since that time he 
has studied boys whose perceptive faculties seemed dull and 
has found that a large percentage of them are deficient mainly 
in hearing a question that is put rapidly to. them. A device 
that will test the speed of the action of the eye and ear correctly 
within moderate limits of accuracy will be of great practical 
importance in an educational as well as scientific aspect. Physi- 
cal education must bring up to a higher plane of activity each 
physical function that is found to be deficient. To do this the 
examiner must be ever alert to discover undeveloped functions, 
and inventive ability will be frequently required to solve the 
problems presented. 

In this connection it may be well to speak of nasal catarrh 
and its influence on health. The disease may be considered 
as a condition of mal-nutrition of the part affected, due to 
irritation of the trophic nerves. It may appear as an inflam- 
mation of the upper air passages with an increased secretion 
of mucous fluid; or there may be atrophy of the mucous sur- 
faces and of the harder tissues beneath; or there may be ex- 
tensive ulceration, and decomposition of secretions. 

The first form is due to the action of irritants on a super- 
sensitive membrane. The condition can be produced almost 
instantaneously by the inhalation into the nasal openings of 
snuff from pulverized tobacco, acrid fumes, dust, etc., but the 
hyperaemia is temporary if the irritation is not repeated. 
Sudden changes from a warm to a cold almosphere do not 
give the system time for the nice adjustment to environment 



66 Personal History and Examination of the Special Senses. 

that enables men to live in every climate where food can be 
found. The result is a continued irritation of the mucous 
surfaces of the air passages and a resulting inflammation with 
thickening of the superficial tissues until the normal nutrition 
of the part is lost, and disease becomes seated. This swelling 
may close the openings of the eustachian tubes, and impaired 
hearing is the result. Treatment is usually successful, and 
hence the importance of examining the nasal chambers if the 
history discloses any suspicion of defect in this locality. The 
other forms of catarrh are often quite as distressing without as 
favorable a prognosis, but relief will not be sought in vain. 

The sense of smell in the atrophic and erosive forms of 
catarrh is often entirely lost, and in all cases is deranged. This 
sense may be tested by inhaling odors that are bland and 
unconnected with articles of food, as musk, attar of roses, etc.* 

The olfactory nerve is perhaps more intimately connected 
with the brain tissue than any other, being apparently a pro- 
longation of the brain through the cribriform plate to the 
nasal walls. As many cases of headache are due to a bad 
condition of the surfaces where this nerve is spread out we 
should examine such cases for ulcerations, tumors, malfor- 
mations and displacements that may cause occlusion or pressure. 

The sense of taste is closely allied with that of smell, but 
is not so important an indication of the condition of the organs 
with which it is connected. It is a sense with great capacity 
for education, as it was the boast of Roman epicures that they 
could tell by the taste of a fish whether it was caught above the 
Bridge or below. A taste may be acquired for the most nauseat- 
ing substances. Children have been known to cry for cod-liver oil. 
But while the sense of taste is not important in its relation to 
health, the condition of the mouth may well occupy our atten- 
tion in discovering those facts in a man's condition that make 
for health or debility. A clean tongue indicates good diges- 
tion; while a coating indicates some abnormal condition of the 
stomach or liver or pharynx. A cracked tongue means dyspep- 
sia. The tonsils should not protrude beyond the pillars of the 
fauces; the general surface of the pharynx should be smooth 
and clean and of light pink color; the teeth should be sound or 
filled and clean ; the vocal cords should be a light pinkish yellow, 

*Scripttire — Thinking, Feeling, Doing, p. 124. 



Personal History and Examination of the Special Senses. 67 

and the tracheal rings below look like white bands between 
which pink tissue can be faintly discerned . 

The temperature should be taken with the bulb of the 
thermometer placed under the subject's tongue for two min- 
utes. This should be a record of 98.4° F. without a varia- 
tion of half a degree. If the temperature is below normal note 
carefully the general conditions and repeat the test at some 
future time. About one or two per cent of cases have a sub- 
normal temperature. The instrument should be carefully 
washed in an antiseptic fluid after using and it is well to have 
a cup of saturated solution of boracic acid into which the 
mouthpiece of spirometers, etc., can be placed after taking 
records with them. 

The tests of urine for albumen and sugar should be prac- 
ticed until the examiner is sure of his ability. The chemicals 
now prepared by leading manufacturing chemists and drug- 
gists leave little except skillful manipulation to the examiner. 
The record should be repeated if any abnormality is found 
and the subject placed under the advice of a physician. 

The director of a gymnasium should always recommend 
some other physician to cases needing medical care. 



GS Test of Strength. 



CHAPTER V 



TESTS OF STRENGTH. 



The importance of strength tests as a department of an- 
thropometry demands that special attention be given to it 
at present. The earlier tests that were applied in anthro- 
pometrical investigations related to the size or mass of the 
various parts of the body, and it was supposed that high re- 
cord, coupled with a good proportion, constituted a highly 
desirable condition and that exercise might be prescribed on 
this basis. Practical experience, however, soon demonstrated 
the absolute need of other data than those relating to bulk 
and proportion if exercise were to be prescribed appropriate 
to the capacity of the individual. The large man is not always 
the strong man, and with equal truth it may be said that the 
strong man is not always the man of high endurance. The 
working muscle is a machine that depends upon two factors 
for its efficiency. First, it must have size, or an adequate 
aggregation of cells, each one of which is involved in the activity 
of the whole as the total strength of the muscle is made up of 
the sum of the strengths of the individual cells composing it. 
Second, it must have adequate innervation in order to set up 
the metabolism that sets free the stored energy. If continued 
exertion is to be considered a third important factor appears, 
namely sufficient circulatory activity to bring fuel to the cells 
and to sweep away combustion products. The variety in the 
girths of different individuals, especially in the first half of life, 
may be attributed in some degree to the difference in the size 
of the muscles, but the modifications may be largely due to 
the presence of storage tissue that has no immediate rela- 
tion to the muscular ability. The girth of the head, on the 
other hand, bears no direct relation that has yet been deter- 
mined to the nerve force that may be applied as a stimulus 
to muscular contraction. We must, therefore, in estimating 
the muscular ability of a person, have other data than the 



Test of Strength. 69 

record of size. Since muscular activity is externally mani- 
fested in forms of strength acting against resistance, it would 
seem plausible that a series of strength tests that should at 
least include the principal groups of muscles would be a safer 
guide in determining the amount of work that may be ad- 
vantageously done, than any other data that can be secured. 
To secure such tests of strength has taxed the ingenuity of 
physical directors in times past, and with some the extensor 
power of the legs in lifting has been considered a fair test of 
the person's muscular power and preparation for work. Others, 
more devoted to that form of exercise ordinarily classified as 
heavy gymnastics , have considered the strength of the exten- 
sors of the arm as a similar indication. Medical men have 
relied particularly on a test cf the contratile power of the flexor 
muscles of the hand. With the advance of anthropometric 
science the inadequacy of local strength tests has been demon- 
strated and gradually methods of testing with fair accuracy 
all the general groups of muscles have been established. The 
earliest forms of dynamometers that have been found fairly 
efficient in securing local tests are shown in the accompanying 
cuts (Figs. 11, 12, 15). The general type of these instruments 
has been that of the elliptic spring. The variation of its con- 
tour being accomplished by pressure or by tension, and recorded 
by an index that is moved forward by the moving side of the 
spring. These instruments have been of French design and 
have been applicable only to a very limited range of use. About 
ten years ago Dr. J. H. Kellogg, the medical superintendent 
of the extensive sanitarium at Battle Creek, Mich., began to 
apply strength tests as a preliminary to the exercise which was 
prescribed extensively as a therapeutic means in his institution. 
The small number of muscular groups that could be measured 
in this way led him to study the possibilities of a mechanical 
device that should be competent by proper adjustment to re- 
cord the acting power of all the skeletal groups with a fair de- 
gree of precision. The first result of his investigation was the 
instrument described in a previous edition of this book. His 
instrument as now completed is show in Fig. 32, and consists 
essentially of a frame made of two upright rods, which serve as 
a support to the testing mechanism. This mechanism balanced 
by a counterweight can be readily moved up or down to any 
position, and there fixed by four set screws to the frame. The 



:; 



. cs: c~ ^:-:k^'1. 



mechanism consists of a lever arm terminating in 
which is always the point of application of the force 



r^ 



a handle, 
This lever 
can be moved upon its fulcrum through 
ninety degrees so as to receive force 
applied in a horizontal or in a per- 
pendicular direction. A coupling pin 
transfers this force to a perpendicu- 
lar lever arm which acts against the 
resistance. This resistance is secured 
by the following mechanism: A plun- 
ger is immersed in a cup contain- 
ing mercury by the pressure on the 
handle and the mercury rises until 
a balance is reached by its buoyancy. 
To the plunger is attached a bar with 
cogs that mash into the cogs of a 
wheel that moves a pointer around 
a graduated circle to indicate the 
power applied. The capacity of this 
instrument is suit. - 
cient to record a 
pressure as light as one 
fourth of a kilogram 
and it has been repeated- 
ly subjected to a strain 
of 800 kilograms without injury. In 
connection with Dr. W. A. George. 
Dr. Kellogg has prepared percentile 
charts from the records of the strength 
tests of 600 men and 600 women that 
ma3 T serve us as a basis for the graphic 
representation of the strength of any 
person. (Page 72). 

I can testify from personal observa- 
:ion to the facility and accuracy with 
which exercises may be indicated for a person when his strengeh 
record is graphically presented on one of these charts. The 
general theory and method of the prescription cannot be better 
described than in Dr. Kellogg's own words which are taken from 
the book entitled. "The Art of Massage 




Test of Strength. 71 

"The data afforded furnish exact information concerning 
the capacity of each of the principal muscles in the body. 
Knowing the capacity of each muscle, it is easy to propor- 
tion the work in such a manner as to secure symmetry of de- 
velopment. My plan for accomplishing this is as follows: 

"Take 300,000 foot pounds, one-sixth of a full day's work, 
as the proper daily amount of exercise for a man whose total 
strength capacity is 10,000 pounds, corresponding very nearly 
to the greatest capacity shown upon my table, prepared from 
six hundred men in good health (page 72). I have undertaken 
to establish a definite relation between the strength capacity 
and the total amount of w r ork to be performed. This is ac- 
complished by simply dividing the total amount of work done 
by the total capacity of the muscles; that is, 1,800,000 is divided 
by 10,000, giving 180. In other words, for each pound of 
capacity the muscles are capable of doing 180 foot pounds of 
work daily, an interesting physiological fact thus for the first 
time determined. One-sixth of 180 is 30. Hence it is clear 
that in a symmetrically developed man, w T ith a total strength 
capacity of 10,000 pounds, each muscle, in order to do its pro- 
portion of the 300,000 foot pounds prescribed, must do work 
to the amount of thirty times its lifting capacity represented 
in foot pounds. 

"It is only necessary, then, in order to ascertain the exact 
amount of work to be done by each group of muscles at each 
level, to multiply by thirty the figures of each column of the 
chart. 

"I have made a careful approximate calculation of the 
amount of work done in each exercise or set of exercises, with 
each apparatus in the gymnasium under my supervision. 
It is necessary to know the strength of the medicine, as well 
as the needs of the patient. Knowing the amount of work 
required for each individual and for each set of muscles, and 
also the result obtained from each exercise, it is easy to con- 
struct tables of exercises exactly adapted to any capacity. 
I have arranged ten series of such tables, or day's orders, five 
for each of the two charts. 

"In making a prescription for exercises, I first note the 
total capacity of the individual, and then write down a number 
indicating the day's order which would secure for an individ- 
ual of the given capacity the proper amount of work. Then 
glancing over the chart I note the low point, and check or under- 
score each of these, which indicates to the assistant who sup- 
erintends the exercise in the gymnasium, that the work is to 
be doubled on all such points, so as to secure to the weak mus- 
cles such rapid development and growth as will enable them 
to overtake the rest of the muscles and thus restore muscular 
symmetry. In practice, I find that this method never results 



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Test of Strength. 7 3 

in giving to a muscle more than a full day's work and conse- 
quently there is no danger of injury resulting from this doub- 
ling of the amount of work to be done by the weak muscles. 
In case of complete paralysis of the muscle, it is of course neces- 
sary, at the beginning, to administer the exercise by electrical 
or mechanical means. 

"As a rule I find it sufficient for practical purposes to 
divide the series of total capacities represented upon my table 
into five groups, instead of making a distinct schedule of work 
at each of the levels indicated by the several quantities re- 
presenting total muscular capacity. 

"The ratio which I have established between the muscu- 
lar capacity and the day's work is probably too small for those 
in vigorous health; but I find it well suited for the class of per- 
sons coming under my observation, who are, for the most part, 
invalids or semi-invalids. The man who is training and de- 
sired to develop his whole body to its highest capacity, should 
be required to execute a full day's work — 1,800,000 foot pounds 
of even more. In arranging a day's order of exercise, due 
account is of course taken of the work done in walking, running 
and similar exercises, which may be made part of the program. 

"The patient does not undertake the first day to do all the 
exercise prescribed in the series, but gradually takes them 
up from day to day, as he learns them and becomes able to 
do them, and by the end of two or three weeks he is expected 
to have thoroughly mastered all the exercises given him, and 
to have become able to take each time all that is directed in 
his prescription. At the end of another month another chart 
is made, the changes noted and a new prescription prepared 
according to the requirements. It is a matter of frequent 
observation that the points which at the first examination are 
lowest on the chart, are so improved by the specific exercise 
directed to these particularly weak muscles that they become 
the highest one upon the second chart." 

A study of proportional strength tests and the increase 
during one year among women in their twentieth year, re- 
presenting the records of 100 Smith College students, is pre- 
sented in the following table prepared by Miss Berenson. 

The number 1 and 2 placed after the items indicate the 
first and second measurement respectively, the second being 
taken after an interval of nine months. The figures repre- 
sent kilograms and liters. It is interesting to note that the 
absolute increase for the students strong at the beginning of 
the year is essentially the same as for the weaker students, 
and for those of medium grade, although the proportional 
increase for the weaker students is greater. It would be a 



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— — _ 1 





Test of Strength. 75 

great help to the more complete study of methods of physical 
education, if such records as this from Smith College could 
be secured for the whole group of students, and for every year 
during the college course. Somewhat similar reports have 
been issued from Wellesley and Oberlin colleges, but here 
the whole group is included (see page 97) . 



















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62 


46.5 


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18 


11 


16 


1.8 


2.1 



Foster states that the strength of men and women bear the 
relation of 9 to 5. A more complete comparison is made by 
Dr. Kellogg in the graphic plate (page 74) which shows the 
average strength values for the various muscular groups of 
both men and women. 

It would appear from tests made in secondary schools that 
the strengths of boys in the period of growth, from ten to six- 
teen years of age, show a different rate of increase according 
to the use to which the muscles are called. At this age the 
boy is on his feet most of the time and his principal exercise is 
locomotion. The strength of his legs as shown on the dynomo- 
meter develops much faster than the strength of his arms or 
back. This may be explained partly on the ground that the 
leg length develops more rapidly than the trunk length but it 
is more likely that the increase is due to heredity that has 
stamped an ambulatory power as of more value in the pre- 
servation of the race than prehensile power that was of the 
highest value in the first months of life and that has been 
handed down as a heritage from a remote past, even when the 
power is no longer used. 



76 Test of Strength. 

Another point that should be remembered when considering 
the subject of strength and that is the fact that muscular 
action is the product of two factors, the quality and size of 
the muscle mass and the nerve force that calls it into action 
and determines the degree of its efficiency in contraction. A 
large muscle may be so poorly innervated as to be inefficient 
and a small muscle may be stimulated to greater effort than its 
fibres are able to bear and a rupture will result. 

In a person of high nervous temperament there is usually 
ability to overstimulate the muscles and there is a correspond- 
ing tendency to overdo, while in the phlegmatic there is in- 
ability to compel the best effort of which the muscle mass is 
capable and the person is never strained by effort. The latter 
class is able to work for prolonged periods without exhaustion 
and the former is able to use all his strength in a few seconds 
and then requires a period of recuperation. The test of en- 
durance as well as momentary strength should demand our 
attention in determining the physical qualities of the individual. 



Special Instruments. 



11 



CHAPTER VI. 




SPECIAL INSTRUMENTS. 

The number of instruments that have been invented to 
demonstrate anatomical and physiological facts within the 
past ten years bears witness to the extent and earnestness of 
the study of the human body. Only the principal ones can 
be described here, and that 
briefly. 

An instrument for meas- 
uring the obliquity of the 
pelvis has been invented by 
Dr. Mosher which is of 
especial value to those ex- 
aminers who are working 
with women. It has been 
demonstrated by gynecolo- 
gists that the position of the 
brim of the pelvis as regards 
perpendicularity has a very 
important bearing on the 
health of the pelvic organs. 
The mechanical reason for 
this is apparent to all. To 
measure and determine 
what may be considered the 
normal position and what 
limits may be considered 
safe variations from this 
normal is the province of 
those who have charge of 
the hygiene and physical 
training of women. The ob- 
liquimeter enables the ex- Fig. 37. 

aminer to determine the angle of pelvic tip with accuracy and 
at small cost of time and effort. The instrument as shown 
in Fig. 37 consists essentially of a fixed arm that can be ad- 
justed to the height of the individual. A second arm A, 



. -T-. -MSlr^ V. 




78 



Special Instruments. 



movable upon a pivot, carries a pointer that sweeps over a 
graduated semicircle. The person to be tested stands in an 
ordinary posture, the fixed arm of the instrument is placed at 
the junction of the sacrum and the last dorsal vertebra. The 
movable arm is then swung down until it rests upon the pubic 
symphysis. The reading is then made in degrees as indicated 
by the pointer. A similar instrument has been invented by 
Dr. J. H. Kellogg (Fig. 38). It is based on similar mechanical 
principles, but is somewhat simpler in its mechanism. Prob- 

ablv the amount of 



pelvic tip is of less im- 
portance in men, al- 
though its relation to 
congestive conditions, 
hemorrhoids, etc., may 
yet be demonstrated. 

The measurement 
and abnormalities of 
the spinal contour has 
been for many years a 
somewhat perplexing 
study, and the various 
devices that have been 
originated have nearly 
all been laid aside as 
too inaccurate in their 
results or too compli- 
cated in their manage- 
ment to be of high 
utility. An instrument 
was devised by Dr. G. 
Fig. 38. Demeny of Paris, 

which he called a thoracometer, for showing the exact con- 
tour of the chest at any level. This instrument is made in 
two segments that can be clasped firmly together around the 
trunk. Running through the band and supported by it are 
many little rods that are pressed forward each by a spring, 
and that are held in any position by a single clamp that acts 
on all at the same time. The instrument is mounted on a 
stard so that it can be raised or lowered to be accommodated 
to any height. The rods are all pushed backward and clamped. 




Special Instruments. 79 

The instrument is then placed upon the chest, the clamp is 
released and the springs carry the rods forward until the tips 
rest against the surface of the thorax. The clamp is now ap- 
plied and the instrument removed, laid over a sheet of paper 
and the position of the points of the rods marked with a pencil. 
These dots are then connected, and the exact contour of the 
chest is shown. The thoracometer described above is 
made on the same mechanical principle as a more elaborate 
machine, invented by Zander of Stockholm, for making an out- 
line of the body at any level. It is, however, much simpler 
and equally efficient. 

A second instrument was subsequently devised by the 
same person for tracing the antero-posterior depths at all 
points of the trunk. This instrument consists essentially of 
two small wheels that pass one along the spinous processes 
while the other passes down the median line in front. These 
wheels are mounted upon a frame work that carries pencils 
that mark the outline traversed by the wheels. Obviously 
this instrument can be used for demonstrating changes in 
outline during respiration. 

Instruments for recording outlines of the body have been 
devised by Drs. J. H. Kellogg,.* C. L. Scudder,f and the 
author. The former secured a full-size outline of the body 
by placing the person in a framework for support, while on 
this framework slides, carrying pencils on arms movable in 
one direction, were made to travel up and down keeping one 
extremity in contact with the body. Some very satisfactory 
results have been obtained by the use of this instrument as 
shown by the series of outline drawings of the human form 
issued by Dr. Kellogg. The device of the author was pre- 
pared in 1892 and was exhibited at the meeting of the Ameri- 
can Association for the Advancement of Physical Education 
in Philadelphia, in April of the same year, as a means of giving 
a reduced and exact outline of spinal curves both lateral and 
antero-posterior. 

The instrument is based upon the principle of the panto- 
graph. The form is that of a double trapezium (Fig. 39)— 



*See "Transactions of American Association of Obstetrics and Gyne- 
cology," 1890. 

t Boston Medical and Surgical Journal, 1891. 



80 



Special Instruments. 



one extremity carrying a marker and the other a pointer for 
following the surface to be outlined. The proportional rela- 
tions are such that the instrument produces a drawing one- 
third the size of the object that is outlined. This being a con- 
venient size for reference and preservation. The pantograph 
is hung upon a swinging tablet that is placed at such a height 
as to make it available for receiving the outline of any part 
of the body. The person to be outlined is placed in a frame 
and movable supports are brought against him, at shoulders 
and hips, so that he may not move while the outline is being 
made, which requires only a few seconds. The instrument will 
be found useful in making records of the special cases of deformity 
that may be under observation. Improvements on the in- 




r /IM1 IMA 11/ J 

Fig. 39 



struments there shown have been made by TV. S. Jackson and 
the author. The instrument may now be said to have some 
utility in securing outlines of the trunk and of the spinal column. 
A method of recording abnormalities of spinal curvature 
has been invented by Thomas Elkinton of Philadelphia (Fig. 
40). It consists of a frame the length of the spinal column. 
This frame carries a series of rods that are freely movable 
back and forth. The frame is supported by an adjustable 
stand so that it may be adapted to the height of any indi- 
vidual. The person stands in customary attitude and is sup- 
ported there by a fork-shaped support that is applied to the 



Special Instruments. 



shoulders. The rods are then pushed forward until their 
ends strike against the spinous processes throughout the en- 
tire spinal column. The other ends of the rods play over a 
sheet of paper and their position is 
marked by a pencil, thus giving a 
series of dots that may be connected 
and an outline of the antero-posterior 
curves secured. If at any particular 
level there be any lateral deviation this 
may be measured horizontally and 
indicated by a figure on the chart 
at the level where the deviation 
occurs, and these may then be laid 
off to the right and left of a perpen- 
dicular line and the displacement 
shown graphically. An instrument 
somewhat similar has been made by 
the author to demonstrate chest 
movements during respiration, three 
rods only being used, and these being 
pushed forward by a spring so that 
they follow the movement of the 
wall to which they are applied. The 
other end of each rod carries a marker 
that indicates the excursion of the rod. 
In connection with instruments 
for recording abnormal deviations 
of the spinal column it will be well 
to call attention to such instruments 
as have been designed 
to give us subsidiary 
information in regard 
to the possible cause 
of the curvature. It 
has been noted by ex- 
aminers that in about 
three-fourths of the Fig. 40. 

cases of curvature of the spine there is a decided difference 
in the elevation of the iliac crests. This difference may be 




82 Special Instruments. 

readily noticed by observation of the difference in waist curve 
on the two sides, the greater projection of one hip, and the 
difference in level of the superior spinous processes, both an- 
terior and posterior. 

It may be stated in this connection that apparent de- 
partures of the pelvis from the normal level do not always 
indicate a difference in the lengths of the two legs, as it may 
be caused by pelvic distocia or even by prolonged abnormal 
posture. However, so far as scoliotic curves are concerned 
they may properly be attributed to the uneven base of support 
that is furnished by the laterally tilted pelvis when there is a 
difference in the height in the two sides of this pelvis. It be- 
comes, then, the duty of the examiner to recognize any failure 
in lateral symmetry of bone lengths and to record as far as 
possible his observation, for if the scoliosis be occasioned mechan- 
ically a mechanical remedy will prove efficient and will be, in 
most cases, the only one indicated. To measure the exact length 
of the two lower extremities is not an easy matter and different 
methods have been suggested to accomplish this end; that em- 
ployed by surgeons has been to measure with a tape line from 
the anterior superior spinous process of the ilium to the internal 
malleolus; also to measure to the external malleolus and from 
the umbilicus to the internal malleolus on either side. 

It is essential in taking these measurements that the exam- 
iner do not retain a position on the tape in passing from one 
side to the other, and also that he do not look at the reading of 
the tape until the exact position is determined and the tape 
removed. To discover the spinous process the finger should 
be pressed well down to the lower edge of the prominence, 
where a well-defined point or hook-like projection will be found. 
In no other way can a true landmark be found. The point 
to which measurements are to be taken should first be marked 
with ink or an aniline pencil. 

A test of the accuracy of the ordinary surgical method of 
measuring the length of leg from the spinous process to the 
malleolus has been made by Professor Thomas Dwight, M. D., 
of the Harvard Medical School.* The measurements were 
made on the cadaver and after dissection the actual length of 
the bones was determined. He found that the error was less 

*Boston Medical and Surgical Journal, Vol. CXXXII, No. 18. 



Special Instruments. 83 

than 3 mm. in 41 per cent, of the cases, and that an error as 
large as 1 cm. was made in only 7 per cent, of the cases. The 
probable error is, therefore, very small when the examiner 
is careful and expert in locating the exact points of measure- 
ment. 

A landmark to which attention has been called by anat- 
omists is the comparative height of the gluteal folds on the 
two sides. The value of this record is suggestive rather 
than accurate, for it is found that there is not absolute uni- 
formity of the folds in persons where no pelvic tip can be dem- 
onstrated, but it may be stated that in all cases where there 
is an inequality in the length of legs there will be an unevenness 
in the heights of the folds. A simple instrument for measuring 
this unevenness has been devised by Thomas Elkinton. It 
consists of a ruler with a level attached to it and having a 
parallel ruler of half the length attached to it, as seen in Fig. 41. 




Fig. 41. 

The ruler is held horizontally so that the upper surface touches 
the lower gluteal fold. The parallel portion is then moved 
upward until it touches the higher fold, and the difference in the 
heights of the two portions may be readily measured and re- 
corded. The same person has also suggested a simple means of 
measuring the comparative length of the legs by having the 
subject lie carefully upon a line so that it shall pass between 
heels and along the spinous processes to the middle of the 
occiput. Two light box-like supports are then placed under 
the legs and are pressed firmly against the sole of each foot 
with equal pressure on either side. A difference in the length 
of the extremities will be indicated by a projection of the sup- 
port on the longer side, and can readily be measured by a ruler. 
The method is simple but will not lecord accurately the total 
difference in length, probably because of the partial fixation of 
the pelvis in a somewhat tilted position by the long continued 
posture that has been necessitated. 



84 Special Instruments. 

The author has found that a difference in the height of 
the pelvic crest may usually be determined by having an assist- 
ant press two narrow rulers inward and downward upon the 
sides of the person just above the iliac bones and then measure 
to the under surfaces of the rulers. 

It is not claimed that this gives a true indication of the 
absolute amount of elevation that will be required under the 
low side to render the support of the spinal column horizon- 
tal. A second method that is suggested is a ruler carrying a 
level that is affixed to the caliper section of the measuring 
pole used by the author as shown in Fig. 42. The caliper is 
applied by pressing its arm firmly upon the tops of the iliac 
crest while the person stands in normal position bearing the 
weight equally on each leg. The free end of the ruler is now 
elevated until it is horizontal, and is then fastened by a thumb 

„ screw. The pelvic tip can then 

.*____ ^-^^===ybsn be read in terms of an angle, 

. J= __^ gf?f ^=- T -^ or in terms of linear units 

marked on the upright guide 
Fig. 42 to which the movable arm 

is fastened by the thumb screw and that slides along the fixed 
arm to fit the breadth of the pelvis. Probably all that can be 
claimed for this latter method as an advantage over other 
methods is the ease with which the record is taken, both for 
the examiner and the subject. 

Dr. Wilson has made a platform easily adjustable in 
height by a screw and is accustomed to place the subject with 
the foot of the low side resting on this platform. He then 
raises the platform until the pelvis is horizontal. The ele- 
vation of the platform gives an indication of the amount of 
artificial elevation that should be applied to overcome the 
scoliosis. 

An instrument for recording the bilateral movement of 
the chest in ordinary or forced respiration has been invented 
by Richard Hogner. M. D.* The instrument is applied some- 
what like an ordinary tape at the level at which the move- 
ments of the chest are to be recorded. The only advantage 
of this instrument over the thoracometer of Demeny. lies in 
its adjustability to a higher region of the thorax, but the cir- 

*New York Medical Record, Vol. XI. Xo. 9. 



Special Instruments. 



85 



cuitous route that the tapes traverse in reaching the upper 
thorax invalidates the records made so that the instrument 
has not come into general use. 

A simple device for measuring lateral inequalities of the 
pelvis is shown in Fig. 43, which consists of two sliding arms 
that are moved against the iliac crest after the central pointer 
is placed over the spinous process of the sacrum. 

There is no advantage, however, in this instrument over 
the rod for length, breadth, etc., which can be placed upon the 
pelvis, as for taking breadth of hips at any desirable point and 
then noting if the half of the total breadth falls exactly over 
the spinous process, which should first be marked. 

Some more or less complicated instruments have been made 
for measuring the inclination of the pelvis by Dr. Compton 
Reilly and others, but their utility remains to be demonstrated. 



E 



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Fig. 43. 



86 Graphic Anthropometry. 



CHAPTER VII. 



GRAPHIC ANTHROPOMETRY. 



Within the last thirty years various devices for applying the 
principles of graphic mathematics to the measures and tests 
of men have been invented. These have been the outgrowth 
of the graphic method of Quetelet for showing the mean of 
any part, as chest girth or height, and the tables of averages 
and means published from time to time during the last twenty- 
five years by Dr. Hitchcock of Amherst, and the tables of 
percentages published by Francis Galton and other students 
in anthropology. 

The oldest record of anthropometrical data in any col- 
lege in the country is to be found at Amherst, where from 
1861-2 to this date the students have had the advantage of a 
physical examination, and advice regarding exercise, and a 
record of their general size has been secured. 

In 1867 W. T. Brigham of Boston made a study of the 
proportions of Mongolian emigrants.* In 1869 he began to 
take the measurements of American young men, and for this 
purpose used a list of measurements and records that was 
later adopted in essential form as the list of the American 
Physical Education Association. He measured several hundred 
Harvard students and other men, but never published his data. 

The items given in Dr. Hitchcock's list are extended in 
the record book of Yale by the addition of age, breadth of chest, 
development, condition, exercise, vision, hearing, color of 
hair and eyes, pulse rate, and use of tobacco. The horizontal 
length is omitted. It may be said that at Amherst the record of 
each student is transcribed for him on a table that is compiled 
from the measurements of men of the same height. The table 
here shown on the opposite page gives the averages obtained 
from five colleges, the material having been obtained by one 
man in each institution. 

In 1880 Dr. D. A. Sargent of Harvard began a systematic 

*Proc. Boston Natural History Society, 1867. 



Graphic Anthropometry 



87 



AVERAGES OF COLLEGE STUDENTS 

Amherst. Cornell. Wisconsin. Yale. W. & J. 

AGE 20.8 20.1 20.3 

WEIGHT 61.2 61.3 63.3 63. 63.1 

HEIGHT 1725 1725 1726 1724 1730 

" Sternum 1410 1406 1415 1416 

" Navel 1030 1030 1030 1033 

" Pubis 860 859 864 860 

" Sitting 903 904 903 903 895 

Knee 478 424 451 448 

LENGTH, Sftoulder, Elbow 369 373 370 372 — 

" Elbow to Tip 460 461 462 461 ■ 

" Arm reach 1780 1782 1792 1790 

" Right Foot 260 258 260 258 

" Left Foot 259 258 260 258 

GIRTH, Head 572 570 575 570 

" Neck 353 346 357 350 346 

Chest, dep 839 846 846 

" inf 926 929 934 924 910 

" normal 880 884 878 875 — — 

" at 9th Rib, full 887 

" at 9th Rib, dep — — 824 

" Waist 723 726 731 725 719 

" Hips 893 895 904 888 888 

" Right Biceps 295 298 300 293 293 

Left Biceps 292 283 285 

Right Arm 260 258 259 256 256 

Left Arm 258 251 256 248 250 

" Right Elbow 251 251 231 229 

" Left Elbow 247 246 229 224 ■ 

Right Forearm 267 258 265 264 265 

Left Forearm 261 258 259 258 258 

" Right Wrist 166 165 169 165 165 

" Left Wrist 164 164 167 164 

" Right Thigh 520 513 524 515 507 

Left Thigh 517 511 522 513 501 

Right Knee 361 359 362 357 

Left Knee 359 357 359 359 

" Right Calf 349 354 352 350 339 

" Left Calf 349 348 350 350 339 

Right Instep 241 242 240 233 

Left Instep 239 240 239 234 

BREADTH, Head 155 154 156 155 

" Neck 108 107 107 107 

" Shoulders 430 434 435 410 415 

" Chest 279 273 270 

" Waist 254 252 251 253 

" Hips 323 323 325 323 319 

DEPTH, Chest 187 186 184 

" Abdomen 181 182 

CAPACITY, Lungs 3.78 4.24 4.05 4.00 4.05 

STRENGTH of Back 138 150 

Legs 164 181 

Right Forearm 40 56.8 54 57.3 

Left Forearm 37 54.5 47 50.4 

Pull up 9.5 

' ' Push up 6 . 

DEVELOPMENT, VISION, Left Eye, COLORofEyes, 

CONDITION. HEARING, PULSE, 

EXERCISE, COLOR of Hair, TOBACCO. 
VISION, Right Eye, 



Graphic Anthropometry. 89 

record of measurements of students examined by himself. 
He has endeavored to determine a physical standard for Ameri- 
can college students that should be derived from a tabulation 
of all the measurements that could be secured. The work 
was very comprehensive in scope and the main results have 
not yet been given to the public, but a partial result has been 
seen in the graphic chart that was prepared in 1886 by which 
he was able to give a person an idea of how he compared with 
the whole body of students whose measures had been tabulated. 
A second result was seen in the July and November numbers of 
Scribner's Magazine for 1887, where, in an article on "The 
Physical Characteristics of the Athlete," certain well-known 
men were pictured graphically as well as literally, and thus 
the application of the method was more clearly impressed on 
the minds of persons engaged in physical education. In 1893 
he presented, at the Columbian Exposition at Chicago, graphic 
charts showing the curves of each item for the final period of 
growth for both men and women. 

Meanwhile Dr. Hitchcock of Amherst College, who had 
published tables of average measurements of Amherst students 
of all ages, from fifteen up to twenty-eight years, and tables 
of averages where height instead of age was the basis of tabula- 
tion, issued a table in which the latter averages were arranged 
on a sheet in order from shortest to tallest, by gradation, of 
one centimeter, and the records of an ordinary person could 
be indicated on this new table in a graphic way. In 1887 
an "adjusted averages" table was prepared as a simple ac- 
knowledgement that the tables were compiled from so few rec- 
ords in many cases that there was considerable irregularity, 
and therefore after determining the apparent law of variation, 
the table was made to conform more or less closely to this law, 
and a better sheet for graphic illustration was produced. The 
numerical comparison method that has been in use at Amherst 
for over thirty years has given us the most extensive study of 
young men from sixteen to twenty-five years of age that we 
have. (See pages 90-91) . 

In 1888 the measurements of Yale students for five years, 
that had been taken by the author and that included every 
man in the undergraduate departments for three years and of 



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92 Graphic Anthropometry. 

two other academical classes, except three men, for four years, 
altogether the records of over 2,200 men, were compiled and 
arranged in tabular form according to the method of percen- 
tile grades used by Mr. Galton (see page 88). 

This has furnished a table for graphic illustration and 
personal information that is fairly complete. In graphic use 
it combines (a) the comparison of a man's records with those 
of the whole mass of students ; (b) sl comparison with the mean; 
(c) the statement of the actual numerical size of each part of 
an individual, and (d) its relation to every other part. 

The general form of this table has been found to be more 
satisfactory than any other that has been devised, and it has 
been followed in form by Dr. Hitchcock, Miss Wood and Dr. 
Hanna and, with slight modifications, by Dr. Gulick (page 
93), Dr. Garland and Dr. Pfister. Dr. Baker of Washington 
and Jefferson College has also slightly modified the form, while 
maintaining its general features. 

This percentile table of the measurements of Yale men 
was followed in 1891 by a similar table compiled from an al- 
most equal number of men by Dr. Hitchcock of Amherst College 
(page 94). This table gives an opportunity of comparing the 
average or mean Amherst student with the mean Yale students, 
as each table includes all of the group at each college. 

It should be remarked that in recording certain dimen- 
sions the method varies so as to invalidate the comparison 
for these items. For instance, the height of knee in the Yale 
table is the height to the top of the head of the fibula, while 
in the Amherst table it represents the heights to the tendons 
of the hamstring muscles. The girth of elbows represents 
in the one case the smallest measurements taken above the 
condyles of the humerus, while in the other it represents a 
measurement taken over the condyles. And in breadth of 
shoulders the record in the one case is bi-acromial, while in the 
other it is bi-deltoid. It should also be noted that the strength 
records are taken with entirely different instruments, and 
therefore do not represent so close a comparison as do the other 
records in the table. 

In the strength of forearm on- the Yale table the upper 
figures represent the readings on the dynmaometer, which 
were supposed to be kilograms and were so marked; while the 



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94 



the lower figures in the 
square represent the actual 
value of these records in 
pounds, as determined by 
a test of the instrument. 
This instrument was of 
standard make, and illus- 
trates the unreliability of 
spring instruments, that 
have been used heretofore 
in securing records. The 
double sets of figures in the 
various squares in all these 
tables represent kilograms, 
millimeters and liters and 
their respective equivalents 
in English units. 

A percentile study of 
the records of the Yale stu- 
dents who were in their 
twentieth year of life has 
been made and the result is 
shown on the chart on page 
95. A noticeable feature 
of the results is that this 
tabulation seems to show a 
decided tendency to increase 
in height of students in re- 
cent years. This has also 
been noted in the average 
tables that have been made 
at Yale from the records of 
the freshmen. Another 
point that is unexpected is 



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96 Graphic Anthropometry. 

that the 50 per cent, record in height of the table representing 
men a year younger is the same as that for the 20th year and this 
would seem to show a period of quiescence in growth of height 
at about this period. 

In 1893 Miss M. Anna Wood of Wellesley College tabulated 
the measurements of 1,500 students, and issued the table in 
percentile form like that of the author, (page 98). This was 
followed in 1894 by a similar table (page 97) compiled from 
the records of 1,600 female students of Oberlin College, taken 
and compiled by Dr. Delphine Hanna, a professor in the col- 
lege. The order of items follows the Wellesley form. In 
both of these cases the tables are of high value as represent- 
ing the whole of a group, and we may therefore fairly con- 
sider that the fifty per cent, lines represent the averages of 
the students of Wellesley and Oberlin. 

An interesting study of the physical type represented in 
the two institutions may be made by plotting the fifty per 
cent, line, the twenty-five per cent, line above the mean and 
the twenty-five per cent, line below the mean of one college 
upon the table representing the records of the other. In 
general it will be seen that the Wellesley student is some- 
what larger in general dimensions, while the Oberlin student 
represents more nearly the type that has been popularly at- 
tributed to the Yankee. A comparison of these tables suggests 
a possible influence of environment in producing a racial or 
local typo,' f for in general the ancestry of the Ohio pupil is the 
same as that of the Wellesley pupil. It is possible also that 
the early occupations of these students have differed so widely, 
as also their food supply, as to produce the modifications noticed. 
It should also be borne in mind that the personal equation or 
method in taking the records is marked in the results seen. 

In 1899 Mrs. Anne Barr Clapp of the University of Ne- 
braska tabulated and published a chart of the anthropomet- 
ric records of 1,500 women of that university who had been 
measured by her. The table consists of the arithmetical 
means, for the various items measured, in groups of height 
varying by a centimeter from 149 cm. to 173 cm. (see page 
99). Appended is a sheet ruled in squares for plotting the 
size of an individual according to the standard set by the line 
of figures representing the average for women of her height, 
the same as in the Kellogg chart described below. The rec- 



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100 Graphic Anthropometry. 

ord of the person is divided by the record for the same item 
in the standard line and the resulting percentage valuation 
is marked in the proper square, by a dot or cross, and then 
these are connected by a line giving a graphic picture of the 
items that are above, below or equal to the standard. Thus 
the chart has a capacity for expressing all possible sizes in 
terms of the averages of women of the same height. A com- 
parison of the record at 160 cm. with the 50 per cent, line on 
the Oberlin or Wellesley tables shows some interesting diver- 
gences in physical type. 

In 1893 Dr. Hitchcock of Amherst issued a table made 
up of a determination of averages on the basis of heights; 
that is, he grouped the records of 1,322 students between the 
ages of seventeen and twenty-six years, according to the height 
of the individuals, separating the groups according to a grada- 
tion of one centimeter. His records varied from 160 to 183 
centimeters. He found the averge for each one of these groups 
and arranged them as seen in pages 90 and 91. 

The nearest approximation to the general college average 
is found to be the grade representing the averages of men 
from 172 to 173 centimeters in height. It may be said that 
this table gives us the best standard of the various dimen- 
sions that are characteristic of American young men between 
the ages of seventeen and twenty-six. The arrangement of 
the figures in the squares is the same as that used in the per- 
centile table. This table cannot be used for graphic illustra- 
tion so successfully as can the percentile table, although for 
men of nearly the mean dimensions the table is satisfactory 
or this purpose. In the use of this table it is suggested that 
the method used by Dr. Kellogg in a chart (see page 101) is- 
sued in 1895 could be used to advantage, for it combines a 
high value for graphic purposes, with the reliable standard 
afforded by an arithmetical meande termined for men on the 
basis of their varying height. The fallacy of the supposition 
that a percentile grade represented a standard for an individual, 
as claimed by some, has been pointed out by Dr. Gulick, Dr. 
Boas and others.* Here, however, we have the standard 
determined by mathematical treatment of there cords of persons 
of the same height and the person may then be 'graphically 

♦Papers on Anthropometry published by American Statistical Society. 



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102 Graphic Anthropometry. 

represented in the same way that he could be represented on a 
percentile chart made up from the measurements of persons of 
his own height. This introduces a new and important feature 
into graphic anthropometry, and one table becomes available 
for representing any individual within the limits of the tabu- 
lation in height. The method is well presented by Dr. J. H. 
Kellogg in "The Art of Massage," as quoted below: 

"It is a recognized law that the strength increases in pro- 
portion to the square of the height, whereas height increases 
in simple arithmetical ratio. In order to furnish a basis for a 
more just comparison, two charts have been prepared upon 
the basis of height, including such heights as fall within the 
limits of 58 and 67 inches for women and 63 and 72 inches 
for men. Provision is made for a graphic percentage repre- 
sentation in the diagram occupying the lower half of the chart, 
upon which per cents, may be written at any level from to 
250. To obtain the percentage relation of the person exam- 
ined to the mean-average person of the same height, it is only 
necessary to divide the number found for any item by the 
corresponding number shown in the proper columns for the 
mean-average person of the given height. Having found 
the percentage in this manner a dot is made with a pencil in 
the proper column, and at the level corresponding with the 
percentage shown by the quotient obtained. If the quotient 
is 1, the dot will be made opposite, or in line with 100, and the 
meaning is that the strength of the group of muscles tested 
is equal to that of the mean-average person of the same height. 
If the amount obtained by dividing the number found by the 
number representing the strength of the same group of muscles 
in the average person of the same height is less than 1, as .50 
for example, this represents that the strength of the group of 
muscles examined is only one-half, or 50 per cent., that of the 
mean-average person of the same height. A dot is accordingly 
located opposite to, or in line with, the number 50 in the per 
cent, column. In like manner, points may be located for each 
group of muscles. Connecting the points by lines, we have a 
graphic representation in which the relation of the individual 
examined to the mean-average person of the same height is 
accurately shown (Page 101). All the points in the chart which 
fall below 100 indicate relative inferiority of strength; all the 
points above the 100-line represent relative superiority in 
strength." 

In considering these percentile tables taken from the 
records of college students, it is well to bear in mind several 
points. First — that the percentile table does not furnish us a 



Graphic Anthropometry . 103 

working type or model of proportions in its fifty per cent, line, 
but it is rather a statement of the actual physical size of the 
college community at the time these records were gathered. 
Very few of the records entering into the compilation repre- 
sent physical maturity, although this is more nearly true of 
the tables for women than for men. It is a notorious fact that 
a large percentage of college students have received no ade- 
quate physical training or exercise before reaching college. 
Their lives have been abnormal and unnatural in that, during 
the playing period of their lives, they have been closely con- 
fined to a line of mental processes that dealt largely with ab- 
stract subjects and that deprived them of physical activity. 
As a result of this method of life, muscular sizes must be ab- 
normally small in the great majority of cases, and a table con- 
structed from such measurements will show a man that is truly 
"mean;" To determine so far as possible the variation of the 
fifty per cent, line on the table of Yale measurements from what 
might be expected in a similar table constructed from the 
measurements of men of a like age but who had taken a large 
amount of physical exercise, and who could be considered in 
perfect health, I selected five hundred individuals from two 
thousand and grouped their measurements according to the 
percentile method. The results are shown by the lines repre- 
senting the twenty-five per cent, grades, as well as the mean, 
that are plotted on the regular table as shown on page 88. It is 
believed that this new fifty per cent, line represents a much 
more reliable standard of physical excellence than the line 
representing the mean of the whole college community. 

A glance at these lines shows us several facts: First — 
That the relation between bone size and muscle size varies in 
different types of men, viz., in the short person the muscles 
have a much larger proportional size than in the tall person. 
This has been demonstrated before in other ways and formu- 
lated into a law that the working power of a muscle varies as 
its cubical contents. Second — That there is a direct ratio 
between exercise and bone growth. The lengths of leg in all 
these cases plot higher than length of trunk. Third — A high 
development seems to declare itself in more increase of depths 
than of breadths. Fourth — That there is a direct ratio be- 
tween size of muscles and capacity of lungs. Fifth — That 



ENEBUSKE CHART. 




H = Height (centimeter). 
»';= Weight (kilo.). 
LC ' Lung capacity (liter) 
TS = Total strength (kilo.). 

Wh^Weight-height index (^). 
V= Vital index (£). 

SwmStrength-weight index ( - ). 

Vs« = Vital Strength-weight /LC TS< 
n,dc> l w W ' 

fo= Power index (tS^£) 



Copyright Ay the Boston Normal Schoo 
of Gymitaitiri, /4<y 



Graphic Anthropometry. 105 

girth of waist increases with chest and hips but not in the 
same proportion. Sixth — That high nutritive power is essen- 
tial to high development. Seventh — That muscular and 
nervous strength increases in greater proportion than other 
items ; so we may infer that high strength tests indicate physical 
welfare. Eight — That exercise gives a measurable increase in 
stamina and tends to produce a distinguishable type of man. 
Dr. Enebuske has developed into a practical form the more 
important indices as a basis for graphic use in showing the 
physical condition of a person, (page 104). In this graphic 
diagram Dr. Enebuske presents a line a, representing an in- 
dividual who was too weak to be admitted to class work in 
the school; line b representing the weakest student who was 
admitted to the normal class of the school; line c representing 
the average working capacity of 1,100 female students of 
Wellesley College, from data furnished by Miss M. A. Wood 
of Wellesley; line d on the chart shows the average of the students 
entering the school before the beginning of their gymnastic 
training; line e shows the average of forty-two graduates of the 
school of an average age of twenty-three years; line / represents 
a record of a student whose working capacity corresponded 
most closely to the average working capacity of the graduates; 
line g represents the highest record made by all female students up 
to the date of the paper; line h represents the average Amherst 
student; line i represents a male student of the Normal School 
of Gymnastics ; line / represents a Yale student of the fifty per 
cent, grade. This line represents also the average of fifty naval 
cadets of the United States Navy. Line k represents the rec- 
ord of a male student of the Normal School of Gymnastics, 
as does also the line L This form of chart has been used in 
the Boston Normal School of Gymnastics as a test of the physi- 
cal condition of the students, who are examined monthly, and 
if the curve at any time falls below what may be expected from 
the previous record the conditions of work are examined, and 
so far as possible errors of method are corrected, or, failing to 
find such errors, the pupil is relieved of part or all of the work 
until a physiological condition is reached that will bear the 
work of the school. 



106 Graphic Anthropomotry. 

With the invention of the Kellogg dynamometer and the 
consequent ability to test more accurately special groups of 
muscles, we have put at our disposal a means of extending 
the study of ratios between the size of various parts and their 
working ability, and this ratio may obviously be expressed 
in the form of an index or coefficient; and thus it is believed 
that the graphic chart of the future that is to give an indi- 
vidual a clear conception of his standing as a member of the 
community must show him his relation to others, not only in 
size but in working capacity. And a closer study of method 
will give us coefficients that shall also indicate the quality of 
work, as well as its quantity. Not until this point is reached 
can anthropometry be said to have fulfilled its mission. 

In connection with the arrangement of the percentile 
charts of strength tests there has been a study of the relation 
of strength to weight and to height, and for the mean the 
strength weight index, as determined by Dr. Kellogg, is 37.34 
for men and 23.42 for women. This index as determined 
by Dr. Enebuske is 7 . 5 for men and 5 for women. The differ- 
ence being due to the larger number of tests used by the former. 
The ratio is essentially the same, thus establishing the com- 
prehensive character of the ratio. It is interesting to note 
the nearly similar ratio of 10 to 8 in the foods required for 
men and women, as determined by Dr. At water and published 
in several bulletins issued by the Department of Agriculture 
as dietary studies. 

The relation between weight and lung capacity is probably 
more definite than the relation between height and lung capac- 
ity, because weight is a definite statement of the amount 
of tissue to be supplied with oxygen, while height relates simply 
to the arrangement of the mass, rather than to its amount. 

The statement that for each increase in height of 25 mm. 
we should expect an increase in weight of one kilogram re- 
lates only to the general proportions existing among men, 
whereas the average weight of a transverse section of 25 mm. 
would undoubtedly be greater than this amount. But res- 
piration is physiologically a measure of the cellular activity 
of the body, rather than of the number of its cells, and there- 
fore we should expect those cells that undergo rapid meta- 
bolism, and that consequently ' tax the respiratory function 



Graphic Anthropometry. 107 

or both the supply of oxygen and the elimination of their 
carbonic oxide, to bear a closer relation to lung capacity than 
would total weight. Muscular tissue stands at the head of 
all cellular structure in the vigor and continuity of its activity, 
glandular structure being the only tissue that compares with it 
in the violence of its metabolism. But glandular activity is 
periodical and fairly uniform among all persons, the processes 
being primary and vital, while muscular activity is secondary 
and voluntary. It would seem, then, that muscular size must 
be the measure of lung capacity. Now strength is the expression 
of muscular size and activity i. e., nerve stimulation), and 
therefore the relation between strength and lung capacity 
must be a definite and measureable one. 

The relation between strength and height cannot be direct, 
although some coefficient may be determined that shall express 
it with a fair degree of accuracy; but the mere expression 
of height, without relation to weight or girth records, tells 
nothing of the muscular size, and, as we have seen, this and its 
related nerve influence is the determining factor of strength. 
That tall people are on the average stronger than short 
people does not refute the argument already stated, because 
in general tall people are also heavier and larger in girth than 
short people, and consequently their muscle mass must be 
larger. 

The relation between strength and girth would seem to 
give a coefficient that would be fairly reliable and constant, 
especially if we include in the girths only the girths of the limbs. 
The reason for this exclusion .will be obvious if we consider 
for a moment the fact that limb development cannot be secured 
without a simultaneous development of the muscles of the trunk, 
as the muscles of the limbs are directly connected with the 
trunk, and any phase of their activity is accompanied by a 
responsive contraction of some group of muscles to steady 
the trunk for the support of the force that is to be exerted by 
the movement of the limb — the trunk being a fulcrum, as it 
were, for the lever constituted by the limb. Yet the trunk 
girths may be large from accumulated adipose tissue and the 
limb girths be comparatively small, owing to habits of in- 
activity and scant muscular exercise. In other words, we may 
.have large trunk girths and poor limb girths, but not the re- 



108 Graphic Anthropometry. 

verse. The limb girths, then, are a fair measure of the muscu- 
lar activity of the individual and consequently may be truly 
said to bear a definite relation to the strength of the individual. 
It has been noted as an anthropological fact that in the more 
highly developed races of men the increased size and develop- 
ment of the legs is a characteristic feature. 

If we consider a ratio of height to weight we have an in- 
dication of the excess of storage tissue or of the scant develop- 
ment of the soft tissues and therefore have a coefficient that 
must bear a fairly close relation to strength. This relationship 
could be expressed by another line on the chart of Dr. Enebuske 
and wide divergence from the normal would lead to anticipation 
of poor condition for work. 

A breadth-strength coefficient, or a depth-strength co- 
efficient, would apparently be unreliable for the same reasons 
that operate against a strength-height coefficient. That is, 
we may have breadth representing a possibility for muscular 
attachments, and still these muscles may not be properly 
developed, while in the case of depths, the large upper trunk 
depth would indicate an approximation to the round type 
of chest, which is primitive and not compatible with large 
lung capacity; while large depth of the lower trunk is indica- 
tive of muscular weakness or insufficient oxidative power. 
On the other hand, small depth of chest may be coincident 
with excessively poor muscular development or with a fair 
degree of muscular development and large respiratory power. 
It would seem, then, that neither of these measurements could 
be depended upon as a basis for determining coefficients. 

In 1889 Dr. W. L. Savage devised a chart for use in plotting 
the measures of boys and youths. The scheme is very ingen- 
ious and will be found generally useful when the table on which 
it is based is placed in the hands of instructors. The chart 
can be used for any age and gives absolute record of averages 
rather than comparative. These averages are computed for 
all ages from one to twenty years and arranged in concentric 

circles. 

In 1890 the most completely graphic method that has yet 

been devised was completed by Dr. E. Hitchcock, Jr. It is 

based on the tabulation of 15,000 sets of measurements — all. 



Graphic Anthropometry. 109 

made by physicians who were experienced in the work. The 
figure is drawn from the average of the various measures, 
and lines to right and left show in a perfect manner the rela- 
tion of girths as they are actually found to exist. The rela- 
tion in size of limb girths to semi-girths of the trunk have 
never been so clearly demonstrated before, and therefore the 
chart is an important contribution to artistic anatomy. 

The numerical method of comparison has been the one 
in most general use because the data necessary for making a 
graphic picture of a person's anatomical proportions has only 
recently been made public. The advantage of a graphic 
illustration of physical proportions is as great as the advantage 
of that method in any department of scientific work. It dis- 
closes at a glance what is discovered only after considerable 
time spent in study of figures. It would seem that the union 
of the graphic and numerical methods of stating the propor- 
tions of an individual must be more comprehensive than either 
method alone, and more satisfactory to both instructor and 
student. 

The percentile tables of Dr. W. W. Hastings, that were pub- 
lished in his Manual for Physical Measurements in 1902, are 
the most comprehensive exposition of the sizes of the various 
years of growth from five to twenty years for both girls and 
boys that have been attempted. But the material is not to be 
considered as an actual percentile tabulation but a determina- 
tion of the mean or 50% and then a calculation of the 25% 
records by the method of "Probable Deviation." The Prob- 
able Deviation has been defined to be the deviation from the 
middle value which, in a large series of observations, is as often 
exceeded as attained. This will be the difference between the 
mean and the 25% record. 

This may be computed by adding all the deviations from the 
mean or middle value and dividing this sum by the number of 
observations and multiplying the quotient by the decimal, . 8453. 
This product is plus if above the mean or minus if below. But 
in the practical working out of this method the minus devi- 
ation is not the same as the plus because the growth is not 
uniform and the material is not homogeneous. However the 
computed values are more reliable for comparison than an 
actual tabulation would be, unless the data were to be very 
extensive. 



ANTHROPOMETRIC TABLE 

for BOYS FIVE TO SIXTEEN (5-16) YEARS OF AGE 
PHYSICAL TYPE FOR EACH AGE, AND VITALITY COEFFICIENTS 

(Compiled from the measurements of five thousand four hundred and seventy-six school children) 



< 


_ c 
o.2 

lo 


s 

u 

a. 


■5 

e 

1 
-I 

TcjS 


LENGTHS 

(cent. — inches) 


breadths 
(cent. — inches)- 


EEPTH 

iCENT.- 

-inches) 


GIKTHS 

(cent. — inches) 


STRENGTHS 


COEPFIC1B 


S 


II 


Si 


•v 
X 


JZ 


■$■ 




e 
8 2. 

6« 


ILung 
Capacity 
(Litres — 
Cub. Inches) 


< r~ \ 


RHC — Resp 

Height Coeffi 

V C— Vitality C 

OS HC — Organ 

Height Coefl 


6 


Strength o 
Forearm, ] 
(Kilos— 
Pounds 


Strength ol 
Forearm, L 
(Kilos— 
Pounds 
























■ 


















75 


58 20 
128 03 


1C9 20 
66 60 


88 m 
3485 


174 82 

08 85 


15 57 

6 10 


26 39 
10 40 


24 70 

9 75 


18 15 
7 « 


65 68 
21 95 


10 47 
4 10 


3 64 

222 03 


40 96 
00 10 


36 52 
5o j6 


169 


K H C 


16 


218 


M 


62 90 

lib 38 


163 73 

b4 45 


85 21 

.?.? 55 


168 21 

66 25 


15 14 

5 95 


25 04 

9 85 


23 19 

9 'J 


16 80 

6 60 


54 73 

21 55 

53 78 
2t 15 


8 80 

3 45 

7 13 

2 80 


3 14 

iqt 40 


33 31 

73 28 


29 64 

OJ 22 


35 58 


V O 






25 


47 CO 
104 73 


158 26 
62 JO 


81 92 
.?•? 2J 


161 60 
b3b5 


14 71 

5 80 


23 69 
JO 


21 68 
8 55 


15 45 
6 oj 


2 64 
'bo 77 


25 66 

5b 4b 


22 76 
50 08 


210 84 


O S H 




























































3 07 

/56_oj_ 

2 64 

ibi 00 

2 21 

A?J 05 












75 


53 97 
118 73 


164 99 
b4 90 


85 56 
33 70 


167 55 

66 00 


15 35 

6 oj 


24 95 
9 80 


23 41 

9 20 


17 48 
6 5j 


55 63 
21 90 


10 25 

4 00 


35 09 
77 2t 


29 25 
b4 34 


141 


K H C 


15 


324 


M 


46 95 

103 29 


158 18 

b2 25 


81 68 

32 15 


160 33 

b3 15 


15 00 

5 90 


23 68 

9 30 


22 00 

* 6j 


16 07 

30 


54 55 

2/ 45 

53 47 
2/ 00 


8 44 

J.?o 

6 63 
2 bo 


28 85 

bS 47 

22 61 

49 7? 


24 68 

54 30 


26 09 


V 






25 


39 93 

8785 


151 37 
jo 60 


77 80 
31 bo 


153 11 

60 30 


14 65 
5 75 


22 41 
S*o 


20 59 
5 10 


14 66 
5 75 


20 11 

<# 26 


185 22 


O S H 




































































75 


44 46 

97 8/ 


156 75 
6/ 70 


80 78 
J' 75 


159 33 
62 70 

152 43 

60 00 

145 53 

57 30 


15 25 
6 00 

14 89 

J«5 


23 87 
9 40 


22 38 
8 85 


16 33 
b_45_ 

15 07 

J 9J 

13 81 


55 18 

2/ 70 


9 98 

3 95 


2 G5 

76/ 60 


29 19 
b4 21 

25 37 

55 »r 


27 19 

59 81 


129 


RHC 


14 


435 


M 


39 73 

87 41 


151 02 

59 45 


78 06 

jo 70 


22 78 

* 95 


21 OO 

825 


54 19 

21 30 


8 46 

3 35 


2 30 

//O 72 


23 05 

jo 70 


21 97 


V c 






25 


35 00 

77 or 


145 29 
57 20 


75 34 
29 6j 


14 53 
5 70 


21 69 
5 50 


19 62 
7 7J 


53 20 

20 90 


C 94 

_£_75_ 


1 95 

7/5 64 


21 55 
47 4' 


18 91 
4t 59 


170 51 


O S H 




























































75 


39 15 

8j 00 


149 90 

59 00 


77 56 
50 50 


151 08 

59 50 


15 11 

5 95 


■ 23 07 
9 10 


20 95 
8 25 


15 35 

6 00 


54 46 
2/ 45 


9 83 

-?*5 


2 29 

'59 35 


26 23 

57 81 


23 22 
J/ o5 


116 


K H C 


13 


515 


M 


35 60 

78 32 


145 09 

J7 10 


75 21 

2q bo 


146 02 

57 50 


14 78 

J 80 


22 11 

5 70 


20 18 

7 9J 


14 38 

J6j 


53 58 

21 10 


8 29 

_:LM. 

6 75 

2 6j 


2 03 
J2JJ* 

1 77 
707 57 


22 59 

49 bq 

18 90 
41 57 


20 49 

45 07 

17 76 

39 ob 


13 28 


V c 






25 


32 15 

70 74 


140 28 
JJ 20 


72 86 
25 70 


140 90 
55 50 


14 45 

J6J 


21 15 

8 30 


19 41 

7 65 


13 41 

5 30 


52 70 
20 75 


157 62 


O S H 




























1 


















































75 


&5 P2 

7S 79 


144 97 
57 /o 


75 70 

20 50 


145 06 

57 35 


15 04 

5 95 


22 44 
8 83 


20 f2 

8 10 


15 20 

6 00 


54 12 
21 50 


922 

J- 60 


2 05 

124 b7 


22 37 
49 2/ 


21 34 
4b 93 


102 


R H < 


13 


559 


M 


32 98 

72 55 ! 


140 29 

55 25 


73 59 

2S Q5 


140 42 

55 30 


14 69 

5 80 


21 57 

5 50 


19 56 

7 70 


14 17 

5 bo 


53 34 

2/ 00 


7 80 

3 05 

6 38 

2 JO 


1 83 

111 33 


19 68 

43 29 


18 44 

40 5b 


15 55 


V O 






25 


30 14 

66 3T 


135 61 
JJ 30 


71 48 
28 10 


135 18 
53 25 


14 34 

j6j 


20 70 
5 /J 


18 50 
7 30 


13 14 

J 20 


52 56 
20 70 


1 61 

97 99 


16 99 
37 37 


15 54 

J4 '9 


1C2 86 


O S K 


































! 










































75 


32 23 

70 03 


133 ?3 
J/ 65 


73 50 

28 QO 


140 24 

55 20 


14 95 

5 90 


21 70 

8 50 


19 90 

7 80 


14 80 
5«i 


53 96 
21 25 


8 70 

3 40 


1 87 
7/2 72 


20 40 
43 8b 


18 41 
41 bq 


091 


RHC 


11 


660 


M 


29 P6 

64 8q 


134 90 

53 10 


71 64 

25 20 


135 64 

53 40 I 


14 58 

5 75 


20 98 

825 


18 92 

7 45 


13 89 

5 45 


52 92 

20 85 


7 36 

2 90 


1 66 

700 74 


18 03 

39 09 


16 11 

3b 30 


.13 33 


T O 






25 


27 49 

JO 7i 


130 97 
5' 55 


C9 78 
27 JO 


131 04 
51 bo 


14 21 

J 60 


20 20 
5 00 


17 94 

7 /o 


12 98 
5 15 


51 88 
20 45 


6 02 

2 40 


1 45 

55 76 


15 C4 

34 32 


13 81 

jo 97 


147 16 


O S H 

» 












1 




































I 




























75 


29 96 
bS 93 


135 11 

JJ 20 


72 26 
28 45 


134 61 
S3 00 


14 90 

5 90 


21 01 
8 30 


19 24 

7 55 


14 04 
J 55 


53 29 
2/ 00 


8 24 

3 25 


1 71 

103 93 


17 24 

.77 93 

14 74 

-?2 ^2 


16 39 
j6 06 


079 


R H ( 


10 


498 


SI 


27 85 

6/- 25 


130 95 


70 04 

27 bo 


130 06 
51 20 


14 53 

5 75 


20 26 

8 00 


18 29 

7 20 


13 29 

J 2.5 


52 35 

20 bo 


7 00 

2 75 


1 48 

90 02 


14 06 

30 94 


10 84 


■* 






25 


25 74 
Sbb3 


126 79 

49 80 


67 82 
26 75 


125 51 
49 40 


14 16 
5 bo 


19 51 

7 70 


17 34 

6 5j 


12 54 

4 95 


51 41 

20 20 


6 76 

2 25 


1 25 

76 77 


12 24 
26 9/ 


11 73 
25 82 


137 01 


O S H 






























1 









75 


27 03 

J9 45 


129 C4 
5' 05 


70 01 

27 00 


12S 83 

50 75 


14 88 

5&5 


20 52 
5 /o 


id 06 

7 JO 


13 96 

J JO 


53 46 

21 00 


7 ro 

J 00 


1 T2 
92 34 


15 34 
JJ 76 


13 71 

30 18 


069 


H H C 




540 


M 


25 07 


123 86 

4Q 55 


68 00 

26 5o 


124 70 

49 10 


14 51 

5 7" 


19 78 

7 £0 


18 04 

7 '0 


13 21 

J 20 


52 49 

20 l>5 


6 BS 

2 JJ 


1 33 

S/ oj 

1 14 

bq 72 


13 14 

25 0/ 


11 77 

25 90 


9 34 


vo 






23 


23 11 
jo 85 


122 08 
48 05 


05 99 

2b OO 


120 55 
47 45 


14 14 
J 55 


19 04 
7 .5° 


17 02 

6 70 


12 40 
4 go 


51 r.2 

*o JO 


5 41 


10 94 
24 ob 


83 
ar oj 


135 97 


S II c 






















1 
















































75 


25 00 

54 98 


124 85 
49 15 


08 C2 

26 So 


123 49 
4S0J 


14 76 

J 7J 


20 11 

7 So 


18 59 

7 jo 


13 51 
J j J 


53 26 

20 QS 


7 Ot 

2 So 


1 35 

8 j S3 


12 CO 

27 7/ 


11 07 
24 34 


056 


K H C 




M55 


M 


23 14 

50 QO 


121 31 

47 7J 


60 OO 

2b 00 


119 34 

47 00 


14 44 

5»5 


19 44 

7 65 


17 60 

6oj 


12 89 

J 10 


53 20 

20 55 


5 05 

2 JJ 


1 15 

70 43 

95 

■5* JJ 


10 63 

23 38 

8 66 
/9 oj 


9 53 

20 90 


7 34 


V c 






25 


21 2S 

*6 82 


117 77 
4b 35 


63 98 
.?J 20 


115 19 

45 35 


14 12 

5 55 


18 77 

7 40 


16 73 

6 60 


12 23 

4*J 


51 14 
20 /J 


4 86 

/ go 


7 99 
17 58 


130 09 


O S H C 




























































' 




75 


22 30 
49 0/ 


119 19 
4b <?o 


6C (V. 

26 10 


118 29 

46 60 


14 68 

J 80 


19 64 

7 7J 


18 03 
7 '0 


13 50 

J. -J 


52 86 

20 80 


6 57 
2 20 


1 17 

7/ J7 


10 77 
23 bS 


10 44 

2J OO 


039 


R H C 




544 


M 


21 30 

4b &J 


115 09 

■« 55 


64 08 

25 20 


114 28 

45 00 


14 33 


18 93 

7 4i 


17 14 

6 75 


12 91 

J 10 


51 94 

20 45 


4 58 

7 So 


99 

60 4S 


18 

20 1Q 


8 53 

/S 78 


5 05 


V C 






25 


20 30 

44 Of 


112 19 

44 ^o 


C2 10 

24 40 


110 27 
43 40 


13 98 
5 50 


18 20 
7 >5 


16 25 

6 40 


12 32 
485 


51 02 

20 /O 


3 59 

/ 40 


81 
49 J9 


7 59 
lb 70 


6 02 

'4 JO 


128 93 


O S H C 


























































i 






75 


20 f S 
*5 SO 


114 34 
45 00 


C3 35 

25 00 


172 01 
44 10 


14 F7 

5 75 


19 09 

7 jo 


17 61 

6 90 


13 38 

J 2J 


52 49 

20 bs 


6 16 
2 00 


1 00 

bi or 


8 88 
'9 54 


7 ro 

/6 46 


032 


R H C 




110 


IW 


19 37 

*2 0.? 


110 67 

43 55 


61 35 

24 20 


108 18 

42 60 


14 24 

J bo 


18 43 

7 2J 


16 69 

OJJ 


12 83 

J oj 


51 56 

20 25 


4 29 

1 6j 


83 

jo So 


6 98 

/J jd 


5 70 

12 S3 


4 02 


V c 






25 


18 OC 

39 74 


107 00 

42 10 


59 35 
2; 40 


104 35 
4/ /o 


13 91 

J 4J 


17 77 
7 00 


15 77 
6 20 


12 28 

4 85 


50 63 

19 95 


3 42 

/ 30 


66 

40 77 


5 08 
// 18 


3 90 

8 bo 


124 89 


O S H C 














































































75 


19 01 

41 81 


108 87 
42 80 


61 15 

24 10 


105 32 

41 50 


14 57 
5 75 


18 71 

7 40 


17 39 

6 Sj 


12 02 
. -5 /0 


52 03 
20 50 


4 07 
' JJ 


83 
JO J6 


5 56 
12 "23 


5 14 
// 31 


C22 


K h c 




02 


H 


17 86 

59 29 


105 78 

ft bo 


59 32 

23 30 


102 44 

40 35 


14 21 

J 60 


18 10 

7 ' J 


16 53 

6 jo 


12 39 

4 90 


51 20 

20 /j 


3 42 

* JJ 


67 

40 bo 


4 89 

/o 76 


4 72 

/o jS 


2 61 


v c 




ial 
476 


25 


16 71 

3b 77 


102 69 
40 40 


57 49 

22 60 


99 56 
39 20 


13 85 
5 45 


17 49 
6 90 


15 67 
6 IS 


11 86 

4 70 


50 37 
iq 80 


2 77 
/ 05 


51 

30 84 


4 22 

9 29 


4 30 

9 4J 


120 31 


O S H C 





































Copyrighted by Wm. W. Hastings, Ph.D., The International Young Men's Christian Association Traininz School, Springfield, Mass. 

All measurements are given in both the Common and the Metric Sys- 
tem. The figures in italic represent inches and pounds. To transpose 
centimetres to inches, multiply by . 393 ; kilogrammes to pounds, multiply 
by 2.2; litres to cubic inches, multiply by 61. 



These tables are summarized in the age charts on pages 110 to 
113, but a much more complete exhibit of the sizes of the various 
items of measurement is presented in his tables that corre- 
late age and height and that give a standard for graphic use 

that is available for all school ages. 

The use of photography is a legitimate application of 

graphic principles and it will soon be employed in all gymna- 
siums where scientific study and accurate work is accom- 
plished. It gives an idea of the form of a man that cannot be 
derived from figures or graphic lines, and will therefore show 
results of exercise that figures cannot express. 









ANTHROPOMETRIC TABLE 

for GIRLS FIVE TO SIXTEEN (5-16) YEARS OF AGE 
PHYSICAL TYPE FOR EACH AGE, AND VITALITY COEFFICIENTS 

(Compiled from the measurements of five thousand five hundred and seventy school children) 






1 


IS 


a 

u 


tco 
11 


LENGTHS 
(CBNT.) 


BREADTHS 
(CENT.) 


DEPTH 
ICBNT.) 


GIRTHS 

(cent.) 


STRENGTHS 


cosFFia; 


J3 

X 


JS J? 
■-•§ 
Sin 


"o 
Si 


■O 

3 


JS 

O 




JS 
O 


60 




JO 

83. 

•= >! 


ton £ 

S a; 


c 3.0 


•£ s~ 

c 3_o 
fc.oCJ 


RHC- Res 

Height Coef 

V C— Vitality 1 

OSHC— Orga 

Height Coe 










































75 


54 67 
120 2& 


161 98 
b3 80 


86 78 
34 15 


162 37 
6j oj 


15 43 
6 oj 


25 61 
jo 05 


21 03 
3 30 


17 29 
6 So 


66 05 
22 to 


807 

J 05 


2 45 

■W JO 


28 64 
6j 00 


27 13 

jo 70 


075 


R H 


16 


355 


M 


SO 38 

no 83 


157 93 

b2 20 


84 70 

JJ JJ 


158 30 

b2 35 


15 05 

J 90 


24 33 

o bo 


19 95 

7*J 


16 02 

6 30 


55 00 

2/ 6j 


5 56 

2 20 


2 14 

/JO JO 


24 13 

S3 08 


22 95 

JO jo 


14 33 


Y 






25 


46 09 
tot 38 


ira 88 

60 60 


82 62 
32 55 


154 23 
60 7J 


14 67 
J 7J 


23 28 
9 'S 


18 87 
7 40 


14 75 

J So 


63 95 
21 20 


3 67 

/ JJ 


1 83 
/// tq 


19 62 


18 77 
41 30 


190 22 


O S H 
























































^ 








1 












75 


51 07 

t!2 JO 


161 29 

6j jo 


85 67 
33 70 


161 44 
b3 55 


15 31 

6 05 


2i 83 
9 80 


20 75 
8 20 


16 51 

6 jo 


55 91 
22 00 


872 

J JO 


2 30 

140 15 


28 29 
b2 25 


27 13 
59 07 


084 


R H l 


15 


469 


51 


46 71 

102 77 


156 79 

6/ 75 


83 30 

J2 80 


156 97 

6/ So 


14 96 

5 90 


23 80 

40 


19 76 

7 80 


15 33 

6 05 


54 65 

21 50 


6 55 

2 60 


9 02 

/2J OS 


24 44 

JJ 76 


23 94 

50 40 


18 84 


▼ 






25 


42 35 
93 IS 


152 29 
60 00 


80 93 
J/ 90 


152 50 

60 OJ 


14 61 

J 7 J 


22 77 

9 00 


18 77 
7 40 


14 15 

J 60 


63 39 
2/ 00 


4 38 

/ 70 


1 74 
/06 0/ 


20 69 
45 27 


18 75 
4t 25 


177 39 


O S H 














































































75 


47 88 
105 33 


158 67 
02 45 


83 86 
33 00 


158 64 
b2 45 


15 28 
6 00 


24 01 

9 50 


20 77 

5 20 


15 65 
6 15 


65 17 

2/ 70 


8 57 

3 40 


2 16 

/J/ J2 


25 42 
55 9' 


22 82 
JO 22 


082 


R H ( 


14 


534 


M 


49 99 

94 42 


15317 

60 JO 


80 79 

3t 80 


153 06 

60 25 


14 93 

sss 


22 91 

OJ 


19 70 

7 7J 


14 51 

J 70 


54 14 

21 30 


6 80 

3 70 


1 86 

112 bq 


21 73 

47 So 


19 51 

#2 q3 


13 39 


y c 






25 


37 96 
83 S' 


147 67 
58 IS 


77 72 
jo 60 


147 48 
58 05 


14 68 
J 70 


21 81 
S 60 


18 63 
7 JO 


13 37 
J *J 


53 11 

20 00 


603 

2 00 


1 64 

W 06 


18 04 
JO 60 


16 20 
JJ 64 


163 05 


O S H 


















1 


































H 


















75 


42 39 

93 2b 


154 03 

60 bs 


80 16 
31 SS 


152 66 
60 10 


15 09 
5 90 


23 03 

70 


20 34 

8 00 


15 09 
J 00 


54 65 
21 50 


8 13 

J 20 


1 98 

120 95 


21 87 
48 tt 


20 71 

45 SS 


078 


R H < 


13 


534 


M 


37 04 

83 46 


148 53 

J* JO 


77 44 

30 50 


14711 

S7 90 


14 76 

J 80 


22 03 

8 70 


19 32 

7 60 


14 11 

J SS 


53 50 

2/ 05 


6 67 

3 bo 


I 73 

tos 70 


18 52 

40 74 


17 66 

38 8b 


11 79 


T 






25 


33 49 

73 bb 


143 03 
jo JJ 


74 72 
29 45 


141 66 
SS 70 


14 43 
J 70 


21 03 
8 30 


18 30 

7 20 


13 13 

J 20 


62 45 
20 60 


5 21 

3 00 


1 48 

90 4S 


15 17 
33 37 


14 61 
J2 14 


161 73 


O S H 






































1 






































75 


36 92 
81 21 


147 36 

$8 00 


76 90 
jo 25 


146 16 
S7 55 


14 98 
J 00 


22 22 


19 93 
7 00 


14 68 
3 So 


54 06 

2t 30 


1 62 

3 00 


1 78 

108 46 


18 48 
jo 6j 


17 29 
jSoj 


068 


R K ( 


12 


526 


M 


33 06 

72 73 


143 03 

55 90 


74 33 

20 *J 


140 83 

SS 45 


14 66 

J 75 


21 28 

5 40 


19 OO 

7 so 


13 82 

J « 


53 06 

20 qo 


6 25 

2 45 


1 54 

W 06 


16 04 

35 28 


14 60 

33 33 


9 87 


T « 






25 


29 20 
64 25 


136 70 
S3 So 


71 74 
28 25 


135 50 
S3 3S 


14 34 

j 60 


20 34 
5 00 


18 07 
7 10 


12 96 
J /o 


62 06 

20 50 


4 88 
/ 90 


1 30 

79 66 


13 60 
20 0/ 


12 01 
26 41 


145 64 


O S H 














































































75 


31 68 
bq 8b 


139 64 
SS 


73 32 

28 8 


138 85 

S4 7 


14 90 
J 90 


21 45 
S45 


19 18 
7 SS 


13 94 
J JO 


63 69 

2f 10 


784 
J /o 


1 68 

06 78 


16 66 
J6 S3 


17 13 
J7 7* 


066 


RHC 


11 


523 


M 


99 00 

63 94 


135 16 

JJ a 


71 25 

28 


133 80 

52 7 


14 58 

S7S 


20 31 

S 00 


18 16 

7 AJ 


13 17 

5 20 


62 55 

20 70 


6 63 

3 bo 


1 35 

82 b2 


14 11 

J/ /o 


14 43 

3t 80 


8 84 


T C 






25 


26 32 

S8 02 


130 68 
J/ 4 


69 18 

27 3 


128 75 
JO 7 


14 26 
J 60 


19 17 
7 SS 


17 14 
6 7J 


12 40 
* 90 


61 51 
20 30 


6 42 

2 10 


1 12 

08 4b 


11 66 
35 08 


11 71 

25 83 


133 64 


S H 


! 




- 






























1 


































1 


75 


29 95 

66 04 


135 43 
S3 3 


71 67 

28 2 


134 00 

S28 


14 78 
J «o 


20 64 

a 10 


18 87 
7*> 


13 76 
J#> 


63 14 

20 00 


7 20 
285 


148 

90 59 


15 20 
33 SO 


13 83 

JO 49 


059 


R H < 


10 | 517 


M 


91 16 

S9 So 


16189 

J/ 7 


69 56 

*74 


129 01 

SO 8 


14 46 

J 70 


19 86 

7 So 


17 90 

7 OJ 


13 09 

J /J 


52 05 

20 50 


6 05 

2 40 


1 27 

77 OS 


12 98 

28 bt 


11 63 

2J 6j 


7 1% 


T « 


| 


25 


24 37 
S3 74 


127 16 
SO 1 


67 45 
26 6 


124 02 

48 3 


14 14 
J60 


19 08 
7 SO 


16 93 
6 70 


12 43 

4 90 


60 96 
20 /o 


490 

/ 9S 


1 06 
6*7' 


10 76 
23 72 


9 43 

20 77 


130 94 


O S H 


i 





































75 


27 08 
59 7' 


129 90 
5t 1 


68 90 

*7 ! 


127 71 
50 3 


14 70 

585 


20 14 

8 00 


18 48 
7 25 


13 80 
5 40 


62 85 
20 80 


6 73 

2 0J 


1 32 

«0 J2 


12 13 

1 2b 77 


11 27 
24 «7 


051 


K H C 




534 


M 


94 90 
S4 90 


12617 

49 7 


67 08 

20 4 


123 25 

48 5 


14 39 

5 70 


10 30 

7 00 


17 65 

6 qs 


13 11 

5 IS 


51 94 

20 *J 


5 C2 

2 20 


1 14 

69 7J 


10 05 

i 22 '7 


9 68 

21 3 J 


6 56 


▼ c 






25 


22 72 
jo 08 


122 44 
483 


65 26 
15 7 


118 79 
40 7 


14 08 
5 55 


18 16 

7 20 


16 82 

6 6j 


12 42 
4 00 


51 03 
20 10 


4 51 

/ 75 


97 

J8 98 


1 

7 97 


8 00 
1783 


128 77 


O 3 H C 












































































75 


23 93 
52 76 


123 70 
487 


68 12 

268 


121 66 

47 9 


14 60 

5 70 


19 C2 

7 75 


18 05 
7 '0 


13 19 

J 20 


52 17 

20 55 


6 21 
•? 45 


1 16 

70 bS 


10 90 

24 04 


10 11 

22 JO 


041 


H H C 




S31 


M 


22 17 

48 88 


12016 

47 3 


66 06 

26 


117 44 

4b 2 


14 29 

5 to 


18 90 

7 45 


17 78 

6 75 


12 60 

4 95 


51 27 

20 20 


5 05 

2 00 


99 

60 /« 


9 26 

20 42 


8 81 

'9 « 


5 12 


T O 






25 


20 41 
45 00 


116 62 
45 9 


64 00 
25 2 


113 22 
44 5 


13 98 

5 50 


18 18 
7 /J 


16 31 

6 40 


12 01 

4 70 


50 37 
1985 


3 89 

'55 


82 

49 OS 


7 C2 
/6 So 


7 61 

ib jb 


124 94 


O 3 H C 














































































75 


22 47 
49 55 


118 29 
40 5 


65 C2 
2J 9 


115 66 

45 6 


14 54 

5 70 


19 12 

7 so 


17 55 

6 00 


13 07 
J 15 


51 79 

20 40 


5 68 

2 2J 


99 

bo 81 


9 49 

20 93 


8 48 

/5 69 


036 


R 11 C 




514 


M 


20 70 

45 04 


114 05 

45 7 


63 71 

25 1 


112 01 

44 r 


14 22 

J bo 


18 42 

7 2 S 


16 68 
6.S5 


12 55 

¥ 9J 


50 93 

20 OJ 


4 70 

7S5 


83 

jo 77 


7 48 

ib jo 


6 60 

'4 JJ 


4 27 


▼ O 






25 


18 93 
41 73 


HI 61 
43 9 


61 80 
24 3 


108 36 
42 b 


13 90 
5 50 


17 72 

7 00 


15 81 
6 20 


12 03 

4 75 


50 07 
10 70 


3 72 

1 45 


67 
¥0 73 


5 47 
12 07 


4 72 
/o 4/ 


122 07 


O S H C 








I 




































































75 


19 96 

44 02 


113 36 

44 5 


63 35 

24 8 


110 72 
43 6 


14 43 

5 05 


18 45 
7 30 


17 28 
6 80 


12 93 
5 10 


51 38 
20 20 


4 84 
/ go 


85 


6 40 
74 7/ 


5 CO 
12 J4 


025 


R H C 




352 


MC 


18 50 

40 80 


109 00 

43 2 


6t 35 

24 / 


107 16 

42 2 


14 06 

J 50 


17 75 

7 00 


16 31 

6 40 


12 38 

4 00 


50 37 

/o £0 


3 87 

' JO 


71 

43 30 


5 17 

77 40 


4 83 

10 b4 


2 94 


V c 






25 


17 04 

37 58 


106 44 
4' 9 


59 35 
23 4 


103 CO 
40 8 


13 C9 


17 05 

6 70 


15 34 
6 00 


11 83 

4 70 


49 36 
'9 40 


2 90 

7 /O 


57 
J4 76 


3 94 

8 bg 


4 06 

8 g4 


U7 C9 


O S M C 












\ 


































1 




























75 


18 78 
4' 42 


108 96 

42 g 


61 47 
24 2 


106 16 
4' 7 


14 41 

5 70 


18 44 
7 JO 


17 10 

6 70 


12 48 
5 05 


51 15 
20 10 


t 43 

/ 2J 


67 
40 go 


5 13 

77 30 


5 07 
// 7* 


020 


R H C 




183 


M 


17 32 

38 to 


105 38 

4' 5 


59 31 

23 3 


102 25 

¥° 3 


13 99 

5 SO 


17 71 

7 00 


16 17 

35 


12 35 

485 


SO 23 

'9 75 


3 59 

/ 40 


58 

JJ SO 


4 72 

10 41 


4 56 

70 06 


2 33 


V O 




otai 
6661 


25 


15 86 

34 ob 


101 80 
40 1 


57 15 
22 4 


98 34 
J9 9 1 


13 57 

J JO 


1G 98 
6 70 


15 24 
6 00 


11 86 
4 bs 


49 31 
/o 40 


2 75 

/ OS 


49 
JO 10 


4 31 

9 J2 


4 05 

8 94 


117 75 


O S M C 














II 






















1 



Copyrighted by Wm. W. Hastings, Ph.D., The International Young Men's Christian Association Training School, Springfield, Mass. 

All measurements are given in both the Common and the Metric Sys- 
tem. The figures in italic represent inches and pounds. To transpose 
centimetres to inches multiply by . 393 ; kilogrammes to pounds, multiply 
by 2.2; litres to cubic inches, multiply by 61. 



114 The Law of Growth. 



CHAPTER VIII. 



THE LAW OF GROWTH. 



The presentation of the law of growth has been accom- 
plished in various ways. The underlying principle, how- 
ever, in most of these methods, depends upon the approxi- 
mation of any group of measurements to the binomial curve, 
as first demonstrated by Quetelet. The measurements may 
be formed into symmetrical grades according to the percen- 
tile form, or they may be grouped into gradations or series 
according to some common unit; as, for instance, the weights 
may be grouped according to the grades representing kilograms 
or other variations, from birth to maturity, and heights may 
be graded by using the centimeter, etc. as the unit, and all 
the measurements graded from the shortest number at birth 
to the highest number found at maturity. This latter method 
has been followed, by Dr. Beyer in his comprehensive brochure 
on the growth of the United States naval cadets, where he also 
combines it with the percentile method. Records may also 
be grouped according to their relation to some particular part 
that may be taken as a unit or modulus for the other measure- 
ments. This method has been followed by Dr. W. S. Hall in 
a paper on "The Changes in the Proportions of the Human 
Body During the Period of Growth,"* where he considers the 
total height of the body as the modulus, and gives the sizes 
of the other parts in fractions of the total height. This method 
also may be combined with the percentile method, as shown 
by Dr. Hall. The scientific value of this latter method depends 
on the proportional contrast that it presents between parts at 
various stages of growth, as it has long ago been proved that 
there is no fixed relation between the proportions of the various 
parts of the body. Finally we may have the method of arith- 
metical means or averages. This method is applicable to a 

* Journal of the Anthropological Institute of Great Britain and Ireland, 
August, 1895. 



The Law of Growth. 115 

wide range of investigation and gives us a result which is essen- 
tially the same as the fifty per cent, line in the "percentile" 
method, and the mean in the method of "probabilities" and the 
"most frequent value," if the material considered is homo- 
geneous. 

As shown by Quetelet, the method of averages can be 
applied to material that is small in amount and that is not 
uniform, while the method of means can only be applied to 
uniform material. The material represented by a group of 
men in an American college cannot be considered homogen- 
eous and for this reason certain men like Dr. Hitchcock of 
Amherst have preferred to use the average methods in tabu- 
lating their data. A selection of material according to ages 
in these groups of college statistics is still open to the objec- 
tion that the individuals represent mixed racial types, and 
consequently the curve showing the frequency of occurrence 
of values will not conform to a true binomial type. It has 
been shown by Gould in his report of the Sanitary Commission 
that the men from certain regions, notably Tennessee, Ken- 
tucky and Indiana, are of taller type than were found in other 
sections, notably New York, New Jersey and Pennsylvania. 
Obviously a college that contained a large number of students 
from any one to these localities would have the height curve seri- 
ously modified, and the height of most frequent occurrence might 
be changed without changing the average appreciably. The 
average height of students in the various colleges illlustrates 
the fact that there is a difference in type in different parts of our 
country. This may be seen by reference to the percentile 
charts of Wellesley and Oberlin women and the 50% table of 
the women of the University of Nebraska, (pages 97 and 98), 
and by Fig. 44, showing the height and weight of boys. The 
upper group of lines represent heights and the lower weights. 
The solid line is from Bowditch, the dotted line Peckham; the 
dot and dash Gilbert, while the two dots and dash show the 
median values for New Haven boys. 

When, however, the measurements are arranged in per- 
centile grades as suggested by Galton, while the fifty per cent, 
line does not have the authority of the average, it is not the 
only feature of the compilation. This fifty per cent, line, 
as before stated, is found to be essentially the same as the 
average, where the group considered is homogeneous, and in 



116 



The Law of Growth. 



t/tA. 

18 




Fig. 44. 

addition to the determination of this value we know how all 
the records are distributed. As, for instance, we may say 
that one per cent, of all the records in any given item were as 
large as the number found in the corresponding grade at top 
of the table, or as small as the number in the grade at the 
bottom of the chart. It also enables us to trace the varia- 
tion in the group and discover by the departure from the bino- 
mial curve the presence of any material that is not homo- 
geneous, it being assumed and fairly well demonstrated that 
there is a mean around which all human proportions are grouped 
in symmetrical forms. 

The so-called binomial curve depends for its determina- 
tion upon the coefficients of a binomial quantity, asx + y raised 



The Law of Growth. 



117 



to any given power. The numerical value of the coefficients 
may be represented by lines (Fig. 45), and if these lines be 
arranged parallel to each other on a common base and a line 
drawn connecting the tops of the adjacent lines, we shall have 
an approximation to a curve, and this approximation will be 
rendered more complete the higher the power to which the 
binomial quantity is raised. For instance, if we raise % + y to 
the tenth power, we shall have for coefficients 1, 10, 45, 120, 
210, 252, 210, 120, 45, 10, 1. The middle line is the mean around 
which the others are grouped in symmetrical order. This form 
of distribution is found in the arrangement by chance of all 
quantities of similar objects. For instance, if an equal number 



252 



210 



120 



45 



10 



210 



120 



45 



10 
-L 



Fig. 45. 



of black and white balls be placed in a box, thoroughly mixed 
and drawn by chance, in groups of ten, 1024 times, which is the 
sum of the preceding coefficients it will be found that probably 
once all ten balls will be black, once all will be white, and the 
various coefficients in the expanded binomial will represent 
the number of times that the balls would be drawn in the 
relative proportion of black and white that is indicated by 
the relation of the exponents of the two quantities in each 
term of the expanded binomial. The sizes of men in the com- 
munity who have a common ancestry and a common environ- 
ment tend to group themselves in exactly this same order 
about a common type or mean. 

If, now, we arrange any number of measurements of a 
dimension, as of height, weight, etc., in order from the smallest 



118 The Law of Growth. 

up to the largest, dividing them into as many equal divisions 
of size as our expanded binomial has terms, we shall find that 
the numbers in these groups are represented graphically by the 
height of the lines, as in Fig. 45. It is obvious to any one that 
instead of dividing into these eleven arbitary divisions we might 
divide them into twenty divisions, or a hundred, according to 
the gradations of sizes. If one hundred were made the basis 
of the division we should then have the records grouped accord- 
ing to percentages, as was suggested by Galton. This group- 
ing has been found the most convenient that has yet been dis- 
covered, for it determines not only the mean, which in any 
uniform data will be the same as the average or arthmetical 
mean, but it determines the mathematical relation of any point 
in the curve to the mass of material represented by the balance 
of the curve. 

Dr. Boas has called attention in a paper published in the 
report of the American Statistical Association, 1893, to some 
of the causes that prevent the distribution of physical meas- 
urements according to the strict law of chance. He men- 
tions the failure in the uniformity of ancestral type with a 
multiplicity of type in the offspring represented by the data; 
in other words, there is a lack of homogeneity in the data to 
be tabulated. He also mentions the lack of uniformity in 
growth at the various periods, and such material must evi- 
dently be considered by some calculus of variables rather than 
by the simple binomial law. He prefers the method of mean 
variation for statistical purposes. 

In the percentile grade system of tabulation we have 
certain misleading features that should be noted by all persons 
who make use of it for graphic purposes. For instance, it is 
often assumed that the line of any percentile grade represents 
an individual or what an individual ought to be. This fallacy 
results from the association together of data that have no re- 
lation to each other, each column of figures being arranged 
solely with relation to one dimension. If for instance, we 
consider the column representing total height, and then com- 
pare with it two other columns which hear a tabular relation 
to it that is constant, namely, the height sitting and the height 
of pubis, which gives the length of legs, we would find that if the 
measurement of any individual be applied to this percentile 
chart and the total height fall upon the thirty per cent, line 



The Law of Growth. 119 

we would have no right to assume that the height stiting would 
fall upon the same grade, for it may fall on the fifty per cent, 
grade or on the ten per cent., etc., the total height being made up 
essentially of the two records considered, may be the sum of 
one short and one long element so that if the height sitting fell 
upon a higher grade than the total height the length of legs 
would fall upon a lower grade and vice versa. In fact, the 
probability of the two height elements falling on one grade is 
strongly against its occurrence. 

The inter-relation of other proportions may be even less 
distinct than the case mentioned. In studying the growth of 
different individuals, it would seem that a general law of growth 
cannot apply to all cases; and that even the application of a 
law determined for any type as suggested by Dr. Porter, has 
wide limitations, for the relation between the bone growth and 
muscular growth of tall boys is not the same as between the 
bone and the muscle growth of short boys. In the period of 
accelerated growth from twelve to fifteen years of age the in- 
crease of bone lengths is markedly greater than the increase 
in muscular tissue* (this will be seen by reference to the tables 
of Dr. Bowditch, Dr. Porter and others, if we assume that 
weight is a fair index of the growth of the muscular parts), 
while the period from sixteen to twenty-three is a period of 
comparatively slow bone growth and a rapid muscular growth, 
just as in the decennial period from forty to fifty the marked 
increase in weight must be attributed to storage tissue rather 
than to either bone or muscle growth. It would seem to be 
important then that some investigation should be made to 
classify the data according to the general type of individual 
that they represent, and from this classified data determine 
anew the law of growth. 

It should also be borne in mind that the rapidity of growth 
varies in the different sections of the country, apparently 
according to climatic and telluric conditions. Another factor 
to be considered in the study of anthropometric data is the 



*This observation has been formulated by Dr. W. S. Hall as follows: 
"When the vertical dimension of the body is undergoing an acceleration 
of its rate of growth the horizontal dimensions undergo a retardation of 
their rate of growth, and conversely." 



120 The Law of Growth. 

personal equation that is characteristic of each individual 
when working with more or less plastic material. This will 
be especially noticeable in the records of girth and breadths, 
where slight variation in tension occasions a wide divergence 
in records. Attention should also be given to the important 
matter of having a record of all of the group in order to make 
the records reliable for tabulation purposes. If, for instance, 
a percentile chart be arranged from the measurements of such 
students as offer themselves for examination in a college where 
the examination is optional with the students, the grades will 
not conform with any fair degree of regularity to the binomial 
curve, because in general two sets of men will offer themselves 
for examination. First, the athletic group of men who are 
well developed and are proud of the physical record that they 
can make, and who may wish suggestion as to further improve- 
ment. The second group will be made up of physical wrecks 
who find themselves unable to do the college work without 
much physical hardship and who are in hopes of receiving such 
hygienic suggestions as shall enable them to continue their work. 
Between the two groups will come a few men who more truly 
represent the ordinary student and whose influence on the 
chart should be the dominating one. If, then, we are to tabu- 
late by the generalizing method we must have a large mass of 
material that shall have been gathered in such a way as to 
have the errors and the omissions of one group balanced by the 
data supplied by another group, and in the final tabulation 
it will probably be found necessary to treat the resulting curve 
mathematically in order to establish the true values for any 
given grades. When, however, the • whole of any group is 
measured, and by one person, a comparatively small number of 
persons will be found to exhibit the type and the general dis- 
tribution of the records for all such persons. Thus it is found 
that percentile table made from records of five hundred college 
men of the same age (within the limits of one year) that in- 
cludes all the men of that age in college at one time, will re- 
present a closer approximation to the binomial curve than will 
the record of 2,500 men of similar ages gathered from year to 
year under the optional system of physical examination. 

In studying the law of growth attention is called to the 
chart prepared by Schuyler B. Moon of McDonogh, Md., as 
shown on page 122. This table is made by grouping the measure- 



The Law of Growth. 121 

ments of one hundred and fifteen boys between the ages of 
thirteen and fourteen years according to Galton's percentile 
method. The fifty per cent, column represents what we may 
call the mean, and for the sake of comparison the fifty per cent, 
lines from four other charts, prepared by the same author, are 
graphically represented on this one. The first line beginning 
at the left represents the mean of boys between eleven and twelve 
years of age. We notice that the items of height and length, 
the two being similar dimensions, diverge farther from the 
fifty per cent, line of this chart than do the girth or breadth 
measurements, which shows a tendency in the growth of boys 
to increase in girth proportions more rapidly in early life than 
they do in length proportions, while at a later period the re- 
verse is true — the lengths increase more rapidly than girths. 
This demonstrates fully the law that while girth measure- 
ments are accelerated length measurements are retarded, and 
vice versa. 

The next point to which attention is called is the large 
girth of head, it approximating more closely to the standard 
of a boy in his fourteenth year than any other measurement, 
showing that this tissue is developed comparatively early in 
life, and that its percentage of future increase must be small 
as compared with that of any other measured organ. The 
breadth of head rising to essentially the same percentile grade 
as girth shows that the form or shape of head does not essen- 
tially change during the period of growth. Physiology has 
taught us the early growth of the brain that reaches a fair 
approximation to its final size in the eighth year. At birth 
it is 14 . 34 per cent, of the total weight while in the adult it is 
only 2.37 per cent. The muscles grow from 23.4 per cent, of 
the weight at birth to 43. 1 per cent, of the weight in adult life, 
while the skeleton keeps at about the same proportional part 
of the total weight throughout active life, ranging from 16.7 
per cent, at birth to 15. 4 per cent, at maturity. 

The next point to which attention is called is the large 
depth of abdomen and comparatively large girth of waist. 
This represents the infantile type and is followed, as will be 
seen by reference to the two lines upon the right of the chart, 
by a period of retardation in growth. The chest, to some 
extent, partakes of the same change in type, and shows that 



ANTHROPOMETRIC TABLE. 
McDONOGH SCHOOL, McDONOGH, MARYLAND. 

Compiled from the Measurements of 115 Boys between the Ages of 13 and 14 years. 

By Schuyler B. Moos. 

Arranged according to the Percentages indicated at the top. Units : Years, Kilograms, Millimetres, and Litres. 

PERCENT..- 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 -80 85 90 95 

AGE '3-1 »3> 131 '3-3 "3-2 "3-3 13-3 13-3 13-3 '3^5 135 136 136 13 7 13-8 T3.S 14.8 I3.8 13.9 

WEIGHT 27.9 29.2 3^30.3 31.4 31-7 32 M 33-2 33.6 34.D 34-8 35-. 

HEIGHT 1, 

Knee 

Sitting 

Pubic Arcb 

Navel. 

Sternum 1077 

GIRTH 

Head 

Neck 

Chest repose 

Chest full 

9th Rib repose.. 

9tb Rib full 

Waist 

Hips 

R. Thigh 

L. Thigh 

R. Knee 

L Kuee 

R. Calf. 

L. Calf. 

R. Ankle 

L. Ankle 

R. Instep 

L. Instep 

R. Upper Arm .. 

L, Upper Arm . . 

R. Elbow.. 

L .Elbow 

R. Forearm . ., ■ 

L. Forearm 

R. Wrist 

L. Wrist 
DEPTH : 

Chest 

Abdomen 143 

BREADTH : 

Head 140 

Neck 

Shoulders.. 314 

Waist 
Hips... 

Nipples 
LENGTH . 
R. Should.-Elbow 
L. Should.-Elbo* 
R. Elbow-Tip 
L. Elbow-Tip 
R. Foot. 
L. Foot..^.... 
Horizontal -■ 
Stretch . 
CAPACITY OP LUNGS I. 

STRENGTH . 

Luogs .tt 

Back 

Legs 

Chest.-.-. _.. 
Upper Arm 
Forearm 
Total.... 




The Law of Growth. 123 

the "round chest," that is, the deep chest, is a primitive or 
infantile type. 

It may also be well to note that in girth and breadth of 
neck we have illustrated what will be found true in studying 
the measurements of mature people, namely, that a large neck 
is usually found under a large head, and vice versa — the neck 
developing as a support to the superimposed mass. 

In strength we see the arm developed more rapidly than 
the legs — this again pointing to the rudimentary type, as 
demonstrated by Louis Robinson. 

In studying the second line (boys 12-13 years) in relation 
to the first and the central straight line, we may note an ac- 
celeration in the development of lengths as compared with 
the first line and a retardation in other records as compared 
with the straight line. The strength tests show symmetrical 
but comparatively small increase, except in forearm. The 
girth and breadth of head show a slight advance, but com- 
paratively the least increase of all the measurements. If, 
now, we study the fourth (14-15 years) line upon the chart 
and compare it with our central line, we see that it diverges 
more widely at all points than does the second line, while the 
fifth line 15-16 years) bears much the same relation to the 
fourth that the second bears to the first. The lengths have 
now outstripped the girths and breadths, while the girth of 
head and waist show a comparative retardation which indi- 
cates an approximation to their completed growth. What 
is true of the head seems to be also true of the strength tests 
of the arm, while the strength tests of legs and trunk show 
marked acceleration, until they slightly outstrip the standard 
that might be expected from the girths. The depths show 
a retardation, like the head, and we see our boy evolving from 
the round, primitive type, into the broad form of the erect 
animal. 

Let us now glance at these lines, bearing in mind the ages 
that they represent, for here they show in most unmistakable 
manner the law of growth, as first demonstrated in this country 
by Dr. Bowditch in his classic paper. The period of the four- 
teenth year is a period of retarded growth, and is immediately 
followed in the fifteenth year by a period of greatly accelerated 
growth, this being the period of prepubertal acceleration, while 
the retardation is seen to be fully as marked as the accelera- 



124 



The Law of Growth. 



tion and corresponds in its mathematical value closely to it. 
In other words, if we were to draw a line midway between 
the second and the fourth line it would represent on either side 
a year of what may be considered average growth, according 
to the standard set by the space between the first and second 
lines and by that between the fourth and fifth. In other words, 
the acceleration of the fifteenth year is sufficient to at least 
make up for the retardation of the fourteenth. 

The question has often been raised as to the value of the 
percentile method in grouping, small numbers of measure- 
ments, and much doubt has been expressed as to its value by 
prominent anthropometrists. The presentation of this table 
is an unanswerable argument in favor of the position taken 



cm 

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Fig. 46. 



The Law of Growth. 



125 



by the author and others, that a small number of measure- 
Lents is sufficient, when the group considered is complete, 
:o produce a percentile chart that shall represent definitely 
the type of the group considered and that shall not vary more 
:om the true type of the group than the probable error of the 
examiner, and consequently for practical graphic use will 
be as serviceable as a chart prepared from large num- 
bers of measurements, especially where these measurements 
are collected by different individuals and from different groups, 
being subject to the personal equation of the examiner and 
the variations of the local types. 



it* 




71 T? 



126 



The Law of Growth. 



The growth of the male and female child correspond very 
closely until the eleventh year in both weight and height. 

The boy is heavier at birth by one-fourth 
kilogram and taller by a centimeter. During 
the first week of life there is a loss in weight, 
but after that epoch of adjustment to a new 
source of nutrition is passed the increment of 
weight is fairly steady until the eleventh year, 
when the girl begins to grow more rapidly in 

both weight and height and outstrips 
the boy, remaining both heavier 
and taller until the fourteenth year, 
when the boy again becomes taller 
than the girl and in his next year 
he surpasses her in weight. This 
is shown graphically in Fig. 46, 




Fig. 48. 
where the line A A represents the height of boys and BB the 
height of girls; the line CC represents the weight of boys and 
DD the weight of girls. The line EE shows the percentage 
of growth in height for the various years and emphasizes the 
period of retardation and acceleration more than the lines rep- 
resenting the actual increment. 

An interesting and valuable physiological fact is demon- 
strated in the growth of lung capacity a,s shown in Fig. 47.* 



*Studies from the Yale Psychological Laboratory, Vol. II. 



The Law oj Growth. 127 

The dotted line shows the capacity of lungs of boys at the 
various years of life indicated at the bottom of the cut; the 
dash and dot shows the same for girls and the smooth line 
shows the same for both; this varying with weight and finally 
distributing the curves so as to represent essentially the pro- 
portions demonstrated by Kellogg as actually occurring in 
strength tests, and by Foster, Atwater and others, as theoreti- 
cally possible from the metabolism represented by the waste 
eliminated. 

The variations in nerve ability are found to bear a close 
relation to the periods of abrupt variations in the curve of 
growth. This is shown in Fig. 48* where the dotted line rep- 
resents the voluntary motor ability of boys, the broken 
line that of girls, and the solid line both boys and girls. 

*Gilbert. Researches on the mental and physical development of 
school children. 



128 The Percentile Method. 



CHAPTER IX. 

THE PERCENTILE METHOD. 

In studying the distribution of individuals in a group 
there is a tendency to think of some one item of measure- 
ment — usually height or weight — that fixes the status of the 
individual for all other items of measurement, as girth of head, 
breadth of hips, etc. This overlooks the fact of different types 
in form: as the long body with comparatively short legs, the 
long legs with short body, the broad and flat chest, and the 
narrow and deep chest, etc. In the use of a percentile table 
this fallacy is especially likely to occur, for in graphic 
tracings the easy conception of a straight line as showing per- 
fect form is likely to obscure the fact that the standard set by 
a line of figures in any grade is determined by an unrelated 
tabulation of data covering each item. For instance, the 
standard in girth of head is in no way related to the standard 
for breadth of chest. We may eventually secure a coordination 
of items in tabulation throughout the entire list as we now 
have a coordination between height and weight, etc., but at 
present this refinement of tabulation has not been carried out 
because of the expense involved. 

We may then only consider the grade in which the record 
of any item of an individual falls as expressing his relation 
in that one respect to the whole group, and that the low or 
high value is of consequence as an indication of heredity ex- 
pressing its type, or of possibility in the way of future develop- 
ment. 

The preparation of a percentile table is carried out as 
follows: The records available are arranged in order from 
the smallest to largest in convenient groups. If height is 
the item being tabulated, the records are grouped so that 
those varying by less than a centimeter are put together, viz., 
the records from 1600 mm. to 1610 mm. are put in one group; 
those from 1610 to 1620 in another, etc., or the groups may 
be made smaller by massing by themselves the records within 
gradation of 5 mm., as from 1600 to 1605, 1605 to 1610, etc.; 
or they may be made larger by including the records that 
are within limits of 2 cm., as from 1600 to 1620 mm., etc. 
The groups by centimeter grades are found to be convenient 
for this item of height while for some items like breadth of head, 
height of knee, etc., grades as low as 1 mm. will be more satis- 
factory. 

In using centimeter groups for height, or other items, it 
will be well to use a decimal as the center of the group, so that 



The Percentile Method. 



129 



in a fairly exact way we may speak of the average height of 
the group as being the decimal around which the group is ar- 
ranged. We therefore would make the groups run from 1595 
to 1605 mm., 1605 to 1615 mm., etc., so that we could speak 
of the first group as having an average height of 1600 mm., 
and the second as having an average of 1610 mm., etc. This 
would obviously not be strictly true of any group except the 
one that included the mean or 50 per cent, record of the 
series, as the number of individuals is large the nearer we come 
to the mean or center of the whole group; but it would be near 
enough for ordinary calculations. 

If, now, we take the 2643 height records of the Yale stu- 
dents who were in their nineteenth year of age, as found on 
the books in a period of twenty years, and arrange them in 
the various grades as indicated above, w T e would have the 
following actual groups: 

Record required 
to secure the 



Height Groups, 
in millimeters. 

under 1565 m. m. 
1565 to 1575 
1575 to 1585 
1585 to 1595 
1595 to 1605 
1605 to 1615 
1615 to 1625 
1625 to 1635 
1635 to 1645 
1645 to 1655 
1655 to 1665 
1665 to 1675 
1675 to 1685 
1685 to 1695 
1695 to 1705 
1705 to 1715 
1715 to 1725 
1725 to 1735 
1735 to 1745 
1745 to 1755 
1755 to 1765 
1765 to 1775 
1775 to 1785 
1785 to 1795 
1795 to 1805 
1805 to 1815 
1815 to 1825 
1825 to 1835 
1835 to 1845 
1845 to 1855 
1855 to 1865 
1865 to 1875 
1875 to 1885 
1885 to 1895 
1895 to 1905 
over 1905 
Total. 



No. of men. 
in these groups. 

7 
6 

11 
9 

14 

22 

37 

51 

61 

67 

80 
107 
120 
137 
163 
168 
171 
181 
169 
155 
145 
140 
121 
111 

90 

68 

52 

49 

33 

26 

15 

17 

12 
4 
8 
8 



2643 



Percentile 
Grade . 

%% 

1% 

5 

10 
15 
20 
25 
30 
35 
40 
45 
50 
45 
40 
35 
30 
25 
20 
15 
10 
5 



K% 



No. of men. 

required for nu ~£er rf" men. 
indicated 



per cent. 

13 

26 

66 

132 

264 

396 

529 

660 

793 

925 

1057 

1189 

1321 

1189 

1057 

925 

793 

660 

529 

396 

264 

132 

66 

26 

13 



for required 
per cent. 

1575 
1587 
1614 
1630 
1652 
1668 
1680 
1690 
1699 
1707 
1715 
1723 
1730 
1737 
1745 
1754 
1763 
1772 
1783 
1796 
1809 
1833 
1854 
1880 
0119 



130 The Percentile Method. 

The question will arise as to how the various numbers in 
the last two columns are determined. If we wish to find a 
group at either extreme of the records that should include 
1 per cent, of 2,643 men, we would take the first twenty-six 
men, and if 5 per cent, the first 132 men, etc., the group always 
being computed from the extremes toward the mean record, 
or that record below which 50 per cent, of the men are found 
and above which the other half of the group is found. In the 
present case of 2,643 men, the 50 per cent, record would ob- 
viously be the record of the 1322nd man in the line if the men 
had been placed in line with the tallest man at one end and the 
shortest at the other, and the others arranged in regular gradua- 
tions between these extremes from tallest to shortest. Of 
course, in a practical way, there would be a considerable num- 
ber of men of the same height near the center of the line, but 
there must be, theoretically, a man who would stand in the 
center of the line whose height would be such that half of the 
men would be taller and half shorter than his height, if the unit 
of measurement was small enough. 

In order to arrange these in percentile grades, we first 
determine the number of men who would constitute the various 
percentile groups by calculation. The 1 per cent, groups would 
include the first twenty-six men, counting from either extreme. 
The 2^2 per cent, groups would include the first sixty-six men 
from either extreme. The 5 per cent, group would include 
the first 132 men, etc., and a complete table would be as follows 
for 5 per cent, grades: 

1% = 26 men. 

5% = 132 men. 
10% = 264 men. 
15% = 396 men, etc., as seen on the previous page. 

Now, beginning with the top of the column on the pre- 
vious page, we see there were seven men below 1565 mm. in 
height, and six between that record and 1575 mm., and eleven 
between 1575 and 1585 mm. In other words, there are twenty- 
four records below 1585 mm. But we must have twenty- 
six men in our first group and the question arises as to how 
computation may determine how large a record must be used 
in order to take in two more men. This is easily answered 
by inquiring as to the number of men in the next group that 



The Percentile Method. 131 

includes the men between 1585 and 1595 mm. and finding 
that there are nine. As the group includes those varying within 
10 mm., it is a fair presumption that the nine men are evenly 
distributed in it and for each millimeter there is nine-tenths 
of a man. But we need to include enough of the group to 
make two men and as each millimeter represents nine-tenths 
of a man, we would have to advance into this group as far as is 
represented by the quotient of 2-r f \ = 2. We therefore add 
two to the number at which we closed the addition, and this 
gives us 1587 mm. as the record below which 1 per cent of the 
group is found. If we wish to discover next the record for the 
5 per cent, grade, or below which 5 per cent, of the men would be 
found, we add the numbers in the various groups until we get a 
sum nearest 132, as 5 per cent, of 2643 is 132,— viz. : 7 + 6 + 11 + 9 
+ 14 + 22 37 51 = 157, which is twenty-five too many; but if 
we do not add the last group we shall have twenty-six men 
too few. We find that the desired record must be somewhere 
between 1625 mm. and 1635 mm., and as in this range of 10 
mm. there are fifty-one men, we may assume that there are 
five men for each millimeter, and we must return from the rec- 
ord of 1635 mm. to get twenty-five men less, as far as is in- 
dicated by the quotient of 25 -s- 5 = 5. The 5 per cent, record 
will therefore be 1630 mm. below which 132 men would be 
found. 

In a similar way we find the 10 per cent, record: 157 61 
67=285, which is more than 10 per cent, of the group by 
twenty-one men. The last group added contained sixty-seven 
men in the variation of 10 mm., or 6.7 men to a millimeter, 
and we would have to return from the record of 1655 mm. so 
far as is indicated by the quotient of 21 -s- 6.7 = 3. The 10 per 
cent, record is therefore 1652. 

We may follow this method through the whole column, 
but it will be much more convenient to perform the computa- 
tions if, after we. have found the 50 per cent, record, we begin 
at the bottom of the column and determine the records above 
which the various percentages are found. We shall also have 
a general check on the accuracy of our work by this method, 
for obviously the 50 per cent, record will be the same when 
computed from either extreme, because if we discover a record 
below which half of the men are found and above which half 
are found we have the height of the middle man in the whole 



132 The Percentile Method. 

group if these 2643 men were arranged in line in regular grada- 
tion from the shortest to the tallest. 

Let us see how the computation will proceed from the 
other end of the column. Beginning at the bottom we add 
8+8+4 = 20, which is too small by six men. In the next 
group of ten millimeters there are twelve men, or 1.2 men to 
a millimeter, and to get six men more we would have to en- 
ter this group to the extent indicated by the quotient 6-=- 1.2 = 5. 
If we remember that we are proceeding from the larger rec- 
ords toward the smaller, we will see that we must subtract 
this 5 mm. from the limit of the group that we last added, 
which was 1885, and our 1 per cent, record becomes 1880 mm. 
This record could be found just as easily by adding the group 
from 1875 to 1885 mm., and having, then, too many men by 
six, the 5 mm. would be added to the 1875. The 5 per cent, 
record is readily found by adding, as before, the groups until 
the sum is nearest 132 men. This sum we find to be 123 at 
the 1835 mm. limit which is too few by nine men, so we must 
advance into the next group which contains forty-nine men, or 
4.9 men to a millimeter, to the extent indicated by 9 -5- 4 . 9 = 2, 
and this subtracted from 1835 mm., the upper limit of the next 
group gives us 1833 mm. as the record above which 5 per cent, 
of the men are found. 

In this way we proceed, using as small percentile grades 
as is desired. I have illustrated this gradation of one-half per 
cent, in the previous table (page 129). 

The interpretation that should be given to the deviation 
from the symmetry of the binomial curve where we have a 
curve representing any group of individuals in any item of 
measurement has been attempted by some writers on anthro- 
pometry by assigning it to the presence of sub-groups with 
well-marked peculiarities and with such numbers as to modify 
the mathematical picture of the mass. This may be readily 
seen if we were studying the height of 1,000 men — the records 
representing all the men in five American college classes, and 
one of the college classes in the University of Tokio, where the 
average height of the men was only 5 feet 3 inches. This 
group of, say 200 Japanese records, would cause an asymmetry 
in the line representing the total group and would even disturb 
the mean, or 50 per cent, line, to a very appreciable degree, as 



The Percentile Method. 133 

compared with the mean of a group made up entirely of American 
students. But aside from the lack of homogeneity in the 
material that is studied there is found to be a disturbing factor 
in the curve of human proportions, as seen in western races, and 
that causes a deviation from symmetry at the extremity of 
the curve representing the larger persons of any group. 

For instance, in the matter of weight the mean of Ameri- 
can college men in their twentieth year of age is essentially 
140 pounds and one per cent, of the men are as light as 102 
pounds — a difference of thirty-eight pounds. Now, if the 
curve of proportions is to be symmetrical there should be 1 
per cent, of the men as heavy as 178 pounds, but in fact we 
find that portion of the men as heavy as 190 pounds. 

In other words, the large persons in any group vary more 
from the mean than do the smaller ones. There would be 
found a fair proportion of healthy men who were 50 pounds 
above the mean but none who were 50 pounds under it. 

It is suggested that this fact points to a tendency in the 
human animal to push toward a larger type and that this varia- 
tion points to a biological law that is still potent in producing 
change and that may evolve a different type for the race. It 
would seem to be a fact that the American people are taller and 
heavier than the standard for any of the races that have peopled 
the country by emigration. 

The percentile table inserted here shows a method of 
coordinating the various groups for percentile study of growth, 
although it is only a single step in the direction that may be 
followed almost indefinitely, viz., the age groups may be each 
subdivided into height groups, and these again subdivided into 
weight groups, etc., etc. It will thus be seen that the possi- 
bilities of this method of studying the relation of the various 
proportions of the human body have only been slightly realized. 
It seems not to have been noticed by many compilers of this 
form of statistics that the percentile analysis of a group gives 
information in a specific and exact form that can only be de- 
termined otherwise by more elaborate calculus, as is well illus- 
trated by the 25 per cent, line showing the "Probable Devia- 
tion" that is of high value in demonstrating the variation of 
measurements from the "mean" or "type" or "average." It 
demonstrates also that the plus value of this deviation is not 
the same as the minus value, at least among college men. It 



134 



The Percentile Method. 



would seem that the time is near at hand when more attention 
must be given to the study of anthropometric data and when 
new information will be obtained regarding physical capacity, 
and possibly mental correlations, that are not now imagined. 



Examination by Inspection. 135 



CHAPTER X. 

PHYSICAL EXAMINATION. 
EXAMINATION BY INSPECTION. 

After the measurements of a person have been taken, the 
work of examination and physical diagnosis should begin. 
The measurement is mechanical and could be done correctly 
by any person after a little practice, but a physical examina- 
tion requires the highest product of scientific training backed 
by sound judgment in order to discover the true condition 
of organs and determine the real cause of the disordered func- 
tion or disturbed growth. It may require only a mechanical 
eye to discover a curved spine, but it must be the mechanical 
eye, backed by a thorough knowledge of physiology and anat- 
omy, that can discern the fact and the cause. 

Inspection should be made with the subject entirely nude 
and standing easily. If a military attitude is assumed try 
to get relaxation into the ordinary positions. This can often 
be done by calling the attention to some trivial matter, as 
any peculiarity of the hands or feet, or by having the sub- 
ject step forward or backward a few steps, when he will forget 
his strained position. From the front, notice (1) the general 
contour or relative breadth, (2) the position of the head, (3) 
the position of the shoulders and arms, (4) the curves of the 
trunk and linea alba, (5) the muscular condition of chest, ab- 
domen and legs, (6) any malformation, such as asymmetry, 
tumors, cicatrices, etc. 

From the side notice (7) the antero-posterior or normal 
spinal curves, (8) the depth and mobility of the chest and ab- 
domen, (9) the position of the shoulders, (10) the relation of 
the hips to the loins, or the pelvic tip, (11) the relation of the 
neck to the trunk, (12) the general attitude of the subject, 
or the poise. 

From the rear notice (13) any lateral or spiral curvature 
of the spine and prominence of spinous processes, (14) the 
condition of the shoulders and scapulae, (15) the waist curves, 
(16) any tipping of the iliac crests due to one leg being shorter 



136 Physical Examination. 

than the other or imperfect bone development, (17) the out- 
line and position of the legs, as in knock- knees, bow legs, etc., 
(18) the muscular condition, (19) the condition of the skin, 
and (20) any tumor or malformation, varicose veins and cyano- 
sis. 

Of course the examiner will not look up each one of these 

points in regular order, but he should study each one and after an 
examination go over this list and see how many points there 
are on which he has no clear, definite knowledge, and then 
try on the next case to make the list smaller, until he will 
take in everything at a glance, as it were. There are many 
other matters to which attention might be called, but they 
are mostly amplifications of the above list. 

We include in (1) the breadth of head as giving some idea 
of the tempermant and vitality of the subject. A broad head 
at the base is believed to indicate a greater vitality than is 
found when the head is long and "top-heavy." There is greater 
power of resisting disease and less liability to nervous irrita- 
bility of a pathological character. A thin, weak neck means 
a bad curve forward at the cervical portion of the spine, and 
a consequent flat chest in a large majority of the cases. The 
voice will be uncertain and the throat suffer from catarrhal 
diseases on the slightest provocation. The circulation of the 
head will be poor and congestive headaches common. 

Narrow shoulders mean compression of the upper part of 
the thorax, and less activity of respiration in the apices of 
the lungs. This, with a history of tuberculosis is unfortu- 
nate, because tubercular degeneration usually begins at the 
apex of the lungs and an inactive part is an unhealthy part. 
This fact has led Dr. T. J. Mays to claim, in an article published 
in the Therapeutic Gazette, May, 1887* that the wearing of 
corsets by ladies may be a protection against phthisis, because 
by compressing the abdomen and lower part of the thorax 
costal breathing with a freer use of the apices of the lungs was 
necessitated and a consequent immunit} 7 from tubercular 
degeneration was the result. The fallacy of this theory has 
been repeatedly shown but by no one so completely demon- 
strated as by Dr. J. H. Kellogg, whose investigations regarding 
normal respiration are complete and original. f 

*See Medical News, November 27, 1886. 

fTransactions of the Michigan State Medical Society, 1888. 



Examination by Inspection. 137 

The breadth of chest is one of the three factors in making 
up the "Vital Capacity," and its relation to the breadth of 
waist and hips will give a better idea of the natural strength 
than the size of the biceps. Any depression of the ribs or 
sternum should be noted. I have seen a case of severe hepatic 
disturbance that had resisted medical treatment for many 
months recover more than ordinary health under a series of 
exercises that tended to lift two depressed ribs over the liver 
into a more arched and natural position. 

Notice any elevation of the chest wall in the cardiac re- 
gion, and any transverse depression at about the sixth rib. 
The elevation may be due to enlargement of heart or peri- 
cardiac effusion. The depression is due to faulty habits of 
sitting — the person sliding forward in his chair and sitting on 
the sacrum, instead of on the ischiae. This depression causes 
a pressure on the heart and interferes with the circulation 
and also causes indigestion quicker than plum pudding by re- 
straining the muscular activity of the stomach which is very 
marked during digestion. This "creased chest" is a postural 
deformity. 

Under (2) we should note any position of the head that 
might denote a shortness of the sternomastoid muscles. A 
shortness on one side tends to tip the head toward that side 
and turn the face to the other; if both muscles are short they 
tend to draw the neck forward and tip the face up. This is 
a frequent condition and if well marked gives a very awk- 
ward poise, especially if in (7) we find the cervical curve very 
deep, or the neck slanting forward because of poor support 
from weak muscles. A strong neck is very desirable. It 
not only holds important organs in place and insures good 
circulation in the brain by making the channels direct, but it 
gives an aggressive carriage, and indicates determination and 
pluck. In (3) we observe the slope of the shoulders and the 
relation of the acromions to the sternum. If a line be drawn 
from the tip of the acromion to the base of the neck and con- 
tinued to the spine, it will make an angle with the line of the 
spine which should approximate to 80 degrees. If the muscles 
that support the shoulder be weak, they permit the acromial 
tips to sink, making the angle less, while if these muscles be 
over-developed they draw the tips up and give a stiff, hunched 
appearance that is ungraceful. If the muscles in front be better 



138 Physical Examination. 

developed than those behind, the shoulder will be drawn for- 
ward and down, giving an apparently flat chest with sloping 
shoulders, which is a mark of slack habits and lack of all ex- 
ercise of a natural character. This form is sometimes seen 
among gymnasts who devote themselves to one kind of exercise, 
as horizontal bar practice, etc. The effect of this posture on 
respiration will be evident to every person with a knowledge 
of the elements of anatomy. The person has no energy or 
"sand" because his blood is not properly aerated. The arms 
hang forward, giving the feeble, helpless attitude assigned by 
caricaturists to the innocent "dude." 

By (4) we mean the outline curves of the waist which show 
something of the strength of trunk that may be expected, 
and the outlines of muscles that give the beautiful curves 
seen on the athlete. These lines may not be clearly cut in 
some cases of well-developed muscles on account of the adi- 
pose tissue immediately under the skin, but in every healthy 
person they give character to the anterior wall which other- 
wise becomes as expressionless as a bag of meal. This last 
point will help us in estimating muscular condition (5) which 
cannot be judged altogether by size. 

It is well to remember that, in (6), we must not only decide 
as to the character of the malformation but know what the 
prognosis or probable development will be — what interfer- 
ence with exercise will be caused and what exercises are contra- 
indicated — what will be the influence on health — what does 
it indicate as to the physical stamina or constitutional strength . 
For instance, varicose veins may never have given any trouble 
and may never have been noticed. How long could this condi- 
tion exist unnoticed and what may be expected from it now? 
What exercises should be avoided, etc., etc.? 

In surgery the word tumor means any abnormal enlarge- 
ment of an organ or tissue. Perhaps the most frequent form 
of tumor that will be found is due to rupture or hernia. A 
hernia is a tumor caused by the passage of a portion of an 
organ through the bony, muscular or tendonous wall that 
normally confines it. It may be produced suddenly by a 
severe strain or bruise, or it may be the result of a gradual 
distension of one of the natural openings of the wall. Cases 
of intestinal herina are frequently found, and among young 
men will affect two or three per cent, of all, while among those 






Examination by Inspection. 139 



past middle life it will affect as high as six per cent. Among 
females it is much less frequent. This is due to the less patulous 
inguinal openings in the female and to less exposure in the 
daily avocations of life. Abdominal hernias are classed as 
inguinal, femoral, umbilical, diaphragmatic, etc., according 
to the place where the viscus forces its way through its natural 
support. The small intestine or the omentum is the tissue 
that usually protrudes. 

An inguinal hernia may appear at the external inguinal 
ring as a round tumor of greater or less extent and is then 
called "direct," while if it appears first at the internal ring 
and passes down the canal it is called "oblique." The latter 
form is much more frequent and tends to develop rapidly 
downward, giving the tumor an elongated form with higher 
origin than the direct. 

In femoral or crural hernia the intestine passes down 
through the crural ring under Pouparts' ligament where it 
causes a protrusion of the anterior wall of the thigh in a round 
tumor that lies in the groin just below the fold at the saphen- 
ous opening. It is situated farther externally from the median 
line than the direct inguinal and if large will have its axis in 
a horizontal rather than perpendicular direction. A hernial 
tumor gives a marked impact to the finger of the examiner if 
firm pressure is made while the subject coughs. 

These three forms of tumor must be readily differentiated 
from cystic tumors, varices, glandular enlargements, etc. 

Cysts have a well-marked fluctuation. Varices have fixed 
relations to the venous trunks and subside on the subject 
assuming a horizontal position and fill again on rising even 
if the inguinal rings are supported. Glandular swellings are 
due to some attendant local irritation and are painful and 
unyielding to pressure. Each case of hernia should be re- 
ferred to the family physician or to a surgeon for advice and 
treatment. No gymnastic instructor should take the responsi- 
bility of prescribing exercise for such cases without advice. 
The same may be said of all tumors. 

The antero-posterior curves of the spine (7) are a con- 
cavity in the cervical and lumbar regions and a convexity in 
the dorsal and pelvic. These curves may all be exaggerated 
by disease or occupation or muscular development. Any 
increase in the curves must shorten the total height. Any 



140 Physical Examination. 

weakness of muscles at the back of the neck will permit the 
head to hang forward, thus increasing the dorsal convexity, 
producing round shoulders, or kyphosis. An over-develop- 
ment of the lumbar muscles as compared with those of the 
abdomen will increase the lumbar concavity, causing lordosis. 
The strong back is the straight back in men. 

The gymnastic treatment of lordosis, or abnormal anterior 
curvature, is the only satisfactory one where there is no caries 
or breaking down of bone. The same is true of kyphosis, 
of which Dr. Stedman writes:* "A cure of adolescent kyphosis, 
when of slight degree, may be obtained by exercise alone, with- 
out mechanical support, but it will be found advantageous to 
aid the patient in maintaining an erect posture by suitable 
apparatus. The treatment by exercises in this form of kyphosis 
should never be omitted, since the fault lies chiefly in a want 
of tonicity of the muscular and ligamentous tissues." 

If there is exaggerated curve at any part of the spine, 
there will be more or less compensatory curve in the opposite 
direction at other parts; and, in prescribing exercise, great 
care must be used in deciding which is the primary and which 
the compensatory curve, for an error would make matters worse 
from the development of parts already strong, and the neglect 
of parts that are weak. 

In observing the depth of chest and abdomen (8) and the 
movement of each under respiration, we have a clue to the 
activity of the person. If the chest is deep at the sixth rib 
but thin at the second, the sternum will usually be found un- 
supported by the muscles of the neck; those behind being 
weak and letting the spine slope forward at the upper part 
so that the sterno-mastoid and the scaleni muscles cannot 
raise the chest. This throws all the work of respiration on 
the diaphragm, and the person is unfitted for any athletic 
exercise, and would have a cramp in his side if he were to 
run an eighth of a mile. It is said that a round chest of equal 
girth with a flat one will not show as great a lung capacity on 
the spirometer and my experience corroborates the statement 
if the extreme types are taken. 

If the abdomen protrudes or sags so that the intestines 
seem to be held just above the pubic arch, especially if there 

* Wood's Medical Reference Handbook. See, also, Lagrange's "La 
Medication par 1' Exercise. 



Examination by Inspection. 141 

be a history of hernia, or excessive corpulence, or indiges- 
tion, the matter is of such import as to call for thorough in- 
struction and earnest advice. Much discomfort, ill health 
and physical suffering will be saved such cases, if the abdom- 
inal muscles be developed by persistent exercise — the ab- 
dominal cavity contains quite as important organs of health 
as the thorax, and the competent instructor will not spend 
all his time and efforts in developing the chest. 

In (9) (10) (11) (12) we have some of the points that go to 
make up the carriage or general appearance of the subject, 
and they constitute the difference in physique between a West 
Point cadet and a slouching loafer. 

Our rear view of the subject will disclose any lateral cur- 
vatures (13) of the spine, or scoliosis, and we should not only 
see any deformity of this character but should be able to judge 
of its nature, and determine its causation. The curve may 
be simple and confined to one part of the spine, or it may be 
multiple. In the latter case one of the curves is usually the 
primary lesion, and the others compensatory. The reason 
for the compensatory curve is found in the natural effort to 
maintain an erect carriage. If there be a slight curvature 
to the left in the lumbar region it would tend to tip the shoulders 
to the right, but the natural effort to straighten the spine has 
most success where the muscle is stronger, and not at the point 
of greatest weakness, toward which the convexity lies. The 
result is the bending of the upper part into such a position that 
the weight is in equilibrium, and the shoulders fairly level. 
This effort to bend a higher portion of the spine to produce a 
balance of weight usually is the cause of a slighter curve higher 
up in the cervical portion, that restores the head to the erect 
position. Thus a curve to the left in lumbar region may cause 
another higher up to the right, in dorsal region, and another 
still higher to the left in the cervical portion of the spine. If 
this explanation is correct it is plain that the predisposing cause 
of scoliosis must be due, in a large majority of the cases, to 
the weakness or uneven development of the muscles and liga- 
ments that support the spine. If the muscular strength 
and activity of one side be greatly in excess of that of the 
other, the spine must of necessity be drawn to that side which 
will throw the convexity toward the weaker side. If this 
principle obtains in all the anatomical relations — and its 



142 Physical Examination. 

influence cannot be denied — no better argument could be used 
in favor of training for bilateral symmetry. In connection 
with scoliosis or lateral curvature of the spine there is nearly 
always a twist of the spinal column on its long axis producing 
a backward protrusion of one side while the other is pushed 
forward. This deformity is called rotation and its importance 
is quite as great as the amount af lateral displacement. The 
rotation is seen more readily when the subject bends forward — 
one side then appearing higher than the other. 

The fact that girls are affected by spinal curvature more 
often than boys (the proportion being four to one) would seem 
to indicate a need of more robust exercise out of doors or in 
gymnasiums that shall give such a development of the erector 
spinae mass, and all the muscles above the hips, as shall com- 
pare favorably with that of boys. The influence of corsets 
and stays has been repeatedly shown to be the cause of great 
muscular debility in the parts constricted, and all medical 
authorities assign a large part of responsibility for curvatures 
to their use. The lumbar muscles of the female have a com- 
paratively larger field of origin at the pelvis and should be cor- 
respondingly strong, but under the differentiation of civiliza- 
tion and the corset, the female waist has degenerated into a 
backache. 

Pressure on a muscle tends to drive the blood out, and if 
it be continuous, the circulation is impaired. This condition 
means bad nutrition of the muscle, and that leads to imper- 
fect development or to actual atrophy. Is it any wonder then 
that a physician hears from his female clients one long com- 
plaint of w^eak backs, backaches and general debility! 

The remedial exercises for curvatures need only be sug- 
gested here, as the only treatment is forcible straightening 
and proper exercises. The care should be exercised on the 
weakest spot, which, in some way, "must stand the strain." 
Suspension, as on the rings and bars, and the direct exercise, 
either active or passive, of the degenerate muscle is the general 
plan of treatment. 

The prominence of the spinous processes are of diagnostic 
value in locating weak spots. If the interspinous ligaments 
have been strained and stretched by lack of muscular sup- 
port or bad habits of posture, as sitting back on the hips, and 
letting the weight of the trunk press the lumbar vertebrae, or 



Examination by Inspection. 143 

a pernicious habit of letting the head hang forward, the saw- 
toothed appearance of the spine, as the subject bends well 
over, will disclose the fact. Notice the alignment of these 
processes as the subject is bent over and straightens up. A 
failure of one or two, here and there, to stand in the line, is 
not an indication of disease, but is due to a slight bend in the 
process, as will be seen on examining almost any skeleton. The 
spinal curvature will be indicated by a number of them as- 
suming a general curved outline. 

The mobility of the scapulae (14) varies greatly in different 
people. A more beautiful contour exists when the trapezius 
and rhomboi'dei are strong and short, holding the scapulae 
down and well back to the spine, but the range of arm move- 
ment is not great. A good development of these muscles is 
very desirable as they prevent the shoulders from rolling for- 
ward and flattening the chest. 

In (15) notice the size of the lumbar muscles, with the 
subject bent over. 

It should be borne in mind that a shortness of one (16) 
leg is comparatively frequent and this deficiency causes the 
pelvis to tip with resulting spinal curvature. Distocia, or 
deformity of the pelvis may have the same effect. It is well 
to notice the comparative height of the dimples that mark 
the posterior superior spinous processes of the ilii, as they in- 
dicate to some extent the position of the base on which is 
erected the bony column of the spine. This base should be 
perfectly horizontal. 

The bone of the legs (17) cannot be greatly changed by 
exercise, but something can be done in early life to relieve 
one of the burden of bow-legs or knock-knees. Therefore, 
in the examination of children do not overlook this point, nor 
needlessly turn the attention of the subject to it when there 
is no relief, but occupy his mind with matters that can be im- 
proved and modified. In observing the legs notice any cyanosis 
about the ankles, and varicose condition of the veins, especially 
of the lower leg. In some persons the skin is firm and seems 
to fit the underlying tissues very closely, thus giving support to 
the venous walls, while in other cases the skin is relaxed and 
thin, furnishing poor support to the superficial vessels. If 
we recall the fact that the hydrostatic pressure alone in a per- 
son of ordinary height, while standing, would be a trifle over 



144 Physical Examination. 

one kilogram in the vessels of the foot, and that the friction of 
the current along the vessel wall, the impediment from construc- 
tion of clothing and speed of the current, all add to this pressure 
we can readily see why certain classes of people are especially 
liable to dilation of the veins, and suffer accordingly. Persons 
obliged to stand much of the time without great change of posi- 
tion (as clerks, book-keepers, bench mechanics, etc.) , and very fat 
people who stand a considerable part of the time, are most 
often affected. The pressure on the external iliac vein in cor- 
pulent people is a predisposing cause, as it prevents the free re- 
turn of the blood into the trunk, and the same may be said of 
garters, tight clothing on the thighs, or elastic thigh bands, 
tight belts around the waist, corsets, and any garment or device 
that prevents normal respiration (see illustrations, Chapter 
XIV). The proper advice in these cases is clear. Restric- 
tion should be placed on all exercises like jumping, where the 
feet strike the ground hard; running on pavement, floors, 
etc., bicycle riding, because the pressure of the saddle falls 
on the femoral and saphenous veins, violent exercises, like 
football, etc., etc. Light exercise should be encouraged for 
the better the tone of the tissues, the less giving way will there 
be to pressure. Exercise of the skin to keep it healthy and firm 
— such as massage and cold water baths, to stimulate the con- 
traction of the tissues — will be of assistance. In this condi- 
tion "forewarned is forearmed." Cvanosis is a varicose condi- 
tion of capillary veins and indicates poor circulation. In cyano- 
sis about the trunk search carefully for some heart lesion. 

The condition of the skin (19) will signify much to the 
careful examiner. Not that every subject with acne should 
be set down as dyspeptic, but in an almost intuitive way the 
careful observer will learn to diagnose many internal ailments 
and judge of vices that might otherwise be unknown. There 
is something that cannot be described in the health} 7- , firm, 
velvety skin of an athlete. It must not only be seen, but felt, 
in order to be appreciated. It is better to be rolled in the dust 
by a hearty, healthy wrestler than to shake the flabby, moist 
hand that is placed in yours by some advocate of moral suasion 
and intellectual topheaviness. The skin, like the eye, is the 
mirror of the bodily health, if we only know how to see the 
image clearly. Its firmness, its elasticity, its smoothness, 
its moisture, its odor, its color, its warmth, all are full of meaning. 



Examination by Inspection. 



145 



Physicians often read the complaint in the countenance of the 
patient before his mouth has uttered it. We have in observa- 
tion not only the facial countenance but the expression of the 
whole body. How much, then, should we rightly judge of the 
inner man! The delicate tint seen on the skin of the woman 
who has exercised in the open air, until every tissue proclaims 
her the type of health, is as superior to the rusty covering of 
the dyspeptic house plant as that is superior to the hide of a 
pachyderm. Local diseases may deform the skin but the in- 
dications of general health will be found, if it exists. 

The following table will present in compact form some of 
the more prominent points observed by inspection: 



GENERAL ASPECT. 



(l)Form. 



Front View. < 



Side View. 



Rear View 



Aspect of chest. 



waist. 



legs. 



neck- 



Flat. 

Round. 
< Bilateral asymmetry. 
| Sternum depressed. 
[ Pectoral muscles. 

/ Breadth. 
\ Muscles. 



f 



Bow-legs 
Knock-knees. 
Muscles. 
Sterno-mastoid . 
Lateral muscles. 



Poise of head. 
" " thorax. 
" " loins and belly. 
" " hips. 

Neck. 
Shoulders. 
Waist. 
[ Hips. 
Height of acromions. 
Line of spinous processes. 
Scapulas. 
Pelvic crests. 



I 

Breadth. 



i 



(2)Nutri- > 
tion 



Unduly thin, f g^fPf* .) Atrophy. 



fat 



{ Healthy 



M 



Evenly distributed and firm. 
Unevenly distributed and soft. 
Fatty degeneration. 



146 



Physical Examination. 



[ Acne, furuncles, etc. 



Eruptions. 



Cicatrices. < 



(3)Theskin. \ 



Tumors. - 



Discolorations. 



Eczema. 
Psoriasis. 

Tinea. 

Ulcerations. 
Erysipelas. 



[ Cirsinatus. 
•j Versicolor. 
[ Tricophytosis. 



Traumatisms. 



Bruises. 
Burns. 
Cuts. 

Lacerations. 
Carbuncles, variola, etc. 



Abscesses. 



Sebaceous. 



I 



Hypertrophy. 



Malformation. 



Free. 
Bone. 

Comedones. 
Seborrhcea. 
Sebaceous cysts. 
Ichthyosis. 
Goiter. 
{ Condylomata, callus, etc. 
Chicken breast. 
Retained testis. 
[ Funnel chest, etc. 
f Varicocele. 
I Hydrocele, 
'i Hernia. 
[ Abscess. 
r Lentigo. 
Chloasma. 
Jaundice. 
i Erythema. 
Purpura. 
Cyanosis. 
Bruises. 



Cysts. 



Examination by Palpation. 147 



CHAPTER XL 



EXAMINATION BY PALPATION. 



The use of the sense of touch, or palpation, is of great 
importance in locating tumors and determining chest move- 
ments, viz. : frequency of respiration, vocal fremitus, ronchi, 
frictions, etc. By the eye you can only imperfectly judge of 
size and consistency. An arm may be large, but, if soft and 
flabby, it does not indicate health or strength; while if it meets 
our hand with a proper resistance — not too hard nor too soft — 
we know that it is capable of good things, be it large or small. 
Palpation enables us to say how much fatty tissue underlies 
the skin, and how firm the muscle is under the fat. It is a 
mistake to set every person with abundant adipose tissue in 
the list of "muscles undeveloped." Nor is fat a substance 
of no worth to the physical economy and to be avoided. In 
certain quantities it is of the greatest advantage to health, 
and is an indication of high nutrition. It is so much physiologi- 
cal capital stored up, and is so located as to prevent loss of 
heat by radiation, especially over the more sensitive organs, 
and therefore saves the energy that would be lost in heat. 
This is nature's way of protecting her children from the increased 
severities of the season, for as autumn brings presages of winter 
by her cooler nights, every animal, in health, grows fat, and 
those that are exposed to continued low temperatures, like 
whales, seals, bears, etc., lay up enormous stores of it under- 
neath the skin, where it will do the most good, and over the ob- 
dominal organs and heart. If the supply of food is cut off, the 
fat is consumed to provide vital force for long periods of time. 
The same is true of man, but to a less extent. As civiliza- 
tion has relieved him of many of the exigencies of nature, it 
has modified his requirements, restricting them in some direc- 
tions, and enlarging them in others. The modern civilized 
man needs much less fat than the Esquimaux, because he has 
a milder climate and better facilities for heating his house, but 
he needs some fat to prevent the irritation of the nervous tissues 
during the adjustments of heat production that are so rapid 
in a well-balanced body, when we pass from a cold to a warm 



14S Physical Examination. 

atmosphere and the reverse. This strain is thrown on the 
involuntary or sympathetic nervous system, and this is the 
part that breaks down in the so-called "nervous exhaustion" 
or "neurasthenia/' which is so common. Xot that lack of fat 
stands in causative relation to this disease, but that one source 
of strain is found here. Such persons bear the cold badly and 
seek warmth, their treatment is warmth and nutrition. The 
argument, then, is that a fair amount of fat is conducive to 
health of the nervous system. The same may be said of all the 
other organs. The lean man has no extra physiological re- 
source to fall back upon, if irregularities are forced upon him, 
either in the way of lessened food supply or sleep or greater de- 
mand on his energy, either physical or mental, and his comfort 
and health soon suffer. 

By palpation we may also judge of the temperature and 
moisture of the skin, and thus estimate its activity in excre- 
tion. A healthy skin should be firm and velvety, even in 
texture and activity, slightly moist under or dinar v circum- 
stances but not wet, colored a delicate shade of pink, without 
being flushed or having dilated capillary vessels, as will be 
found common in the clavicular or scapular region. If the 
skin is hot and flushed, it indicates the presence of fever, or 
a local disturbance of circulation, due to deranged nerve activitv. 
If the skin be dry, and tends to form scales, the superficial cir- 
culation is insufficient, and bad digestion is a common accom- 
paniment. Free exercise, shower bathing, massage and fric- 
tion will set things to rights if persistently employed, unless 
the skin be affected by ichthyosis, which '"is a congenital, 
chronic, hypertrophic disease." and hence will be but little 
benefited. Profuse perspiration is found frequently, and 
seems injurious only in prolonging bronchial inflammations 
and general catarrhal conditions, by keeping the clothing damp 
a large part of the time. There is also an increased liability 
to Blight's «lisease from high concentration of urine and chilling 
of the surface on slight exposure. 

Hyperidrosis will be favorably influenced by active exer- 
cise, as the circulatory system will at that time be depleted 
by the free sweating, and will give up less moisture in a state 
of rest. After exercise, the damp clothes removed, the sweat 
washed off in the shower bath, and the skin dried by proper 
massage, leave slight liability of "colds." Local hyperidrosis 



Examination by Palpation. 149 

may seriously impair the health by keeping the feet damp 
and cold and thus induce catarrhal, pneumonic and rheumatic 
conditions. Medical advice is to be recommended in such 
cases, if hygienic precautions — such as cold baths, frequent 
change of clothing, sensible shoes with cloth tops, proper diet 
and regular exercise — do not avail. At times the under and 
inner surfaces of the toes and the outside margin of the foot 
from the little toe back to the instep will appear white and 
swollen in these cases. This condition closely resembles large 
blisters from scalds, but is only a water-soaked, "parboiled," 
state of the epidermal layer, like that seen on the hands of 
washer-women after they have been in hot soap-suds for a 
half-hour. The advantage of a cloth-top shoe is these cases is 
apparent when we think of the comparative ease with which 
moisture passes through woolen fabrics as compared with 
the difficulty of evaporation through leather. 

A condition of anidrosis, or too scanty perspiration, is 
frequent without evident impairment of health. The skin is 
apt to get very dry and harsh, especially in cold weather, 
and often eczema of the hands result. In many of these cases 
there is no general sweating, even in extremely hot weather, 
and perspiration is not copious. 

It may be well to explain that "perspiration" is the term 
applied to the insensible exudation from the sweat glands 
that is evaporated as fast as secreted, while "sweating" is 
the appreciable collection of this exudation in drops of greater 
or less abundance. (See Foster's Physiology.) 

In addition to what we learn of the integument and mus- 
cle by palpation, we detect by it certain movements that 
characterize health or disease. If we place the hands firmly 
on the walls of the chest, letting the fingers press the inter- 
costal regions, there will be felt a movement of the chest on 
each inspiration and expiration, if respiration be normal. 
Any failure in expansion is noticed if there be interference 
with the chest action, from muscular or mechanical cause, 
that is unilateral. There should be bilateral symmetry of 
movement, but this may be hindered by muscular soreness 
from rheumatism, neuralgia, traumatis, etc.; paresis of a 
muscle, or group of muscles; intrapleural effusions; new growths; 
or by solidification of the lung or any considerable part of it. 



150 Physical Examination. 

Malformations may also interfere with bilateral symmetry 
of movement. 

If the subject be asked to repeat some word such as ''ninety- 
nine," or to count aloud, one, two, three, while the hands are 
on the chest, as above described, a peculiar vibration will be 
felt, which is known as the "vocal fremitus." This thrill, or 
vibration, is much more prominent in persons with thin chest 
walls and low pitched voices, than where the wall is thickly 
padded with fat and the voice in high key, on the same principle 
that the low bass strings of a piano, when struck, impart vibra- 
tion to solid articles in the room in an appreciable degree, 
while the high notes have a less perceptible effect. The "vocal 
fremitus" is somewhat plainer on the right side, on account of 
the larger size of the right bronchial tube. A fremitus may be 
caused by other sources of vibration than the voice, as by a 
cough, by mucous rales, by pleuritic friction, and the splashing 
of liquid, when the chest contains liquid and air. 

The "ronchial fremitus," due to mucous in the bronchial 
tubes, is frequently very marked in bronchitis, and felt by 
the subject himself; but the area is circumscribed in most 
cases. The friction fremitus of pleuritic inflammation is faint 
and local in character. In general, those diseases that pro- 
duce solidification of the air cells of the lungs, without obstruc- 
tion of the bronchial tubes, increase the vocal fremitus; while 
those that interpose more air, like emphysema, decrease it. 
Liquids diminish or check it altogether. The scapulae inter- 
fere with the fremitus, as does the liver, the latter not conveying 
the vibrations, and, if pressing firmly against it, preventing 
the chest wall from doing so below the margin of the lung. 

Palpation is of great service in the diagnosis of tumors. 
The fingers are to be placed on one side of the swelling, and 
gentle but firm pressure made on the opposite side of it with 
the fingers of the other hand, by a quick movement of the 
wrist. If the contents of the tumor are liquid a bulging will 
be felt under the fingers, caused by the displacement of the 
fluid., that passes ^as a wave through the tumor, distending 
the sac at one part to accommodate the liquid depressed at 
another. This peculiar wave-like motion, called fluctuation, 
can be well studied by examination of a rubber water-bag 
under varied thickness of covering, having the bag distended 
hard, and again with less water in it, but no air. In cases of 



Examination by Palpation. 151 

ascites the wave impulse is readily felt across the abdominal 
cavity — a light tap with the end of the finger against the side 
being sufficient to start the wave. A close estimate of the amount 
of fluid can be formed in this way, as the wave simply continues 
through the liquid part, and is not propagated by the intes- 
tines or general tissues. 

The apex beat of the heart may also be located by pal- 
pation in a large majority of cases. In many subjects the chest 
wall is thin, and the heart action strong, so that inspection can 
determine the apex impulse with tolerable precision; but if it 
fail to fall in an intercostal space, or the chest wall be thick, 
or the heart-beat feeble, palpation must be used. In this con- 
nection it may be said that for this purpose the ear may be the 
organ of tactile, as well as of auditory impressions. 

The character of acute or chronic inflammatory action 
can often be determined by palpation, as in swellings about 
joints. Tumors and impactions in the abdominal cavity can 
be diagnosed by this process and their general character de- 
termined. 



152 Physical Examination. 



CHAPTER XII. 

EXAMINATION BY AUSCULTATION AND PERCUSSION. 

The condition of the internal organs is determined in 
several ways. Among the most frequently employed, be- 
cause most satisfactory in results, is by listening to the pas- 
sive and active sounds so far as they can be secured to the 
ear. The passive sounds are obtained by percussion, or strik- 
ing the surface over an organ, either with the tips of the fingers 
or a rubber mallet directly, or by laying a solid surface, or the 
finger, firmly against the surface, and striking this. The first 
method is called immediate percussion, and is seldom used, 
except for hard, bony surfaces. The second is called mediate 
percussion, and is applicable to all parts. 

The sounds obtained by percussion vary in quality, in- 
tensity and pitch. The quality of the sound obtained over 
the various organs can only be rudely described, but practice 
will give skill in distinguishing it. The intensity will vary 
according to the surrounding medium, and the pitch will vary 
largely through change in the organs that produce the sound. 

The region of the body most frequently examined by 
percussion is the thorax. The abdomen, especially in condi- 
tions of disease, is often examined by this method (in con- 
nection with palpation), but without the satisfactory accuracy 
that is to be secured over the chest, although it enables one 
to distinguish the outline of solid tumors of hepatic, splenic 
or intestinal origin and the area covered by cystic enlarge- 
ments. 

The method of employing percussion is generally with 
the fingers, although, if many examinations are made daily, 
it is well to use a pleximeter and percussor (see Figs. 20, 21). 
It seems to the writer that the appreciation of vibrations by 
the finger is of considerable importance in assisting the ear 
and, therefore, that digital percussion is better than instru- 
mental. The act is easily performed by laying the fingers 
of one hand firmly over the part to be examined and, with the 
tips of the first two or three fingers of the other hand, or the 
middle finger alone, striking against one of the fingers imposed 



Examination by Auscultation and Percussion. 



153 



on the part with a firm blow, accomplished by a wrist move- 
ment of flection. The force of the blow may be varied to per- 
ceive the difference in resonance, quality and pitch of the sound 
under the conditions, as this may have an important bearing 
on our determination of the case. Forcible percussion sets in 
vibration deeper tissues and, if their condition varies greatly 
from the superficial tissues, there will be a mixed quality to the 
sound that aids in identifying healthy activity, or disease, 
or abnormal position. For instance, if we begin at the 




Fig. 49. 

Showing the normal outlines and positions of the heart, lungs, liver 
and stomach. The light dotted line shows the outline of the lung at 
inspiration, b d, at expiration, fh, and also to lobar divisions at i k I. The 
heavy continuous line shows the outline of the liver. The light line shows 
the location and divisions of the heart. The heavy broken line indicates 
the outline of the stomach. Luschka. 

right clavicle and percuss downward until we reach the 
lower edge of the liver, we shall pass over lung tissue at first 
where the sound elicited under mild or forcible percussion is 
essentially the same; lower down we reach a part of the lung 
that contains the large bronchial tubes when the pitch is lower 
and resonance good, then still lower to a part that is backed by 
the upper convexity of the liver with only the solid diaphragm 



154 Physical Examination. 

and lung between it and the chest . wall. Here under mild 
percussion, the resonance is unimpaired; but under a 
firmer stroke the resonance is found to lose its clearness and 
become duller, and this dullness increases as we percuss to 
the very edge of the lung, where, the sound is flat (see Fig. 
49). The term "flat," as applied to percussion sounds is 
such a quality of tone as is produced when an organ contain- 
ing no free gaseous element is set in vibration by an impact. 
The word "dullness" is comparative only and denotes less 
resonance than should be expected under normal conditions. 

In using the pleximeter we press it firmly against the 
surface, and strike upon it with the rubber percussor. The 
resonance of the instrument is slightly confusing to the per- 
son who has been accustomed only to digital percussion, but 
practice soon enables us to eliminate this sound, as one does 
the sounds of mercantile life while listening to a voice in the 
telephone. Practice alone will give skill in the determina- 
tion of normal or abnormal sounds. It may be remembered 
that for any individual the resonance of the chest is fairly 
constant in health, but that of the abdomen varies continually; 
again, the resonance of the abdomen is always tympanitic 
or flat, while that of the healthy chest is neither. In making 
a physical examination, percussion of the abdomen is useless, 
unless there be a history of abdominal disorder, or inspection 
and palpation indicate something abnormal. 

For convenience in describing any location on the anterior 
aspect of the trunk there has been a long-continued custom 
of dividing the body into a right and left half by a median 
perpendicular line and then designating the portion on either 
side above the clavicle as the superclavicular region, right or 
left. The portion below the clavicle as far down as the third 
rib is called the infra-clavicular region and the part covered 
by the clavicle is called the subclavian region. The mammary 
region extends from the third rib to the sixth. Below the sixth 
rib is the infra-mammary region, extending to the margins 
of the ribs. The lower sternal region extends from the ensi- 
form cartilage to the third costal cartilage, and from this point 
to the sternal notch is called the upper sternal region. From 
the top of the stermine to the cricoid cartilage is the supraster- 
nal region. The limits on the right and left are perpendicular 
jines drawn from the tips of the acromions. At the side the 



Examination by Auscultation and Percussion. 



155 



Limit 



axillary region extends from the summit of the axilla to the 
sixth rib and below this is the infra-axillary space, extending 
to the bottom of the chest. 

The abdomen is divided into nine regions for purposes 
of description, as follows (Fig. 50) : Draw a horizontal line 
across at the level of the narrowest part of the waist and a 
second line at the level of the iliac crests. Draw a perpen- 
dicular line from the middle of Poupart's ligament on each 
side, extending up to the chest. On the outside of these lines 
will be found, above, the right and left hypochondriac re- 
gions extending down to 
the first horizontal line. 
Between the horizontal 
lines will be the lumbar 
regions and below these the 
iliac regions bounded by 
Poupart's ligament. The 
central portion is called the 
umbilical region. Above 
this is the epigastric and 
below the hypogastric re- 
gions. 

In examining a subject 
by percussion it is well to 
begin on the supra-clavicu- 
lar region and percuss 
lightly and then forcibly on each side, and jjress the fingers 
well against the intercostal muscle rather than over the ribs, 
while proceeding to the lower edge of the chest; then percuss 
the right axillary region; then the posterior thoracic, from top 
to bottom, striking on alternate sides in order to discover 
any difference in sound that may exist, and then the left 
axillary space. There should be equal resonance of sound on 
each side behind, unless there be extreme unevenness of muscu- 
lar development, which will slightly dull the sound on the 
strong side; but in front the location of the heart to the left 
of the sternum, and the liver to the right of it, and lower down 
gives a wide variation in sound for similar location on the two 
sides. On the right we usually find the point of liver dullness 
beginning about 2 cm. below the nipple, while the line of flat- 
ness is about 6 cm. below it — the flat area extending about 




Fig. 50. 



156 



Physical Examination. 



the breadth of the hand, or to the edge of the ribs, and around 
to the spine (see Fig. 51). On the left the area of heart dullness 
begins at about the third intercostal space, near the sternum, and 
extends out to a point nearly an inch above the nipple, and 
down for 3 cm., shading off into the flat heart area — that is 
circular above about 5 cm. in diameter and having its center 
at a point half way between the nipple and the center of the 




Fig. 51. 

Showing the areas of percussion dullness and flatness over heart, liver 
and stomach, i k line of beginning dullness around the heart, a d b c 
area of flat sound or without pulmonary resonance, p q line of dull area 
over the liver, e c m I area of flatness over liver, tn n o area of varying 
resonance over the stomach. Weil. 

sternum, and reaching downward to the sixth rib, where it is 
merged in the stomachic resonance (see Fig. 49) . 

The line of stomach dullness is of variable location and 
may not be perceptible at all. 

The percussion sound of the abdomen is tympanitic or 
flat, according to the existence of gas in the intestinal canal. 
In case of ascites, a peculiar wave impulse is started by im- 
mediate percussion that is readily felt by the other hand held 



Examination by Auscultation and Percussion. 157 

against the abdominal wall opposite the point of impact. The 
same is true of cystic tumors in other locations, where the 
walls are protected only by soft tissues, as in effusion into the 
synovial cavity of the knee and other joints, as a result of 
inflammation or hemorrhage. This wave impulse corresponds 
to the fluctuation of palpation (see page 151). 

The area of liver dullness should not extend below the 
lower edge of the ribs, on the right side, while the spleen is 
found well around to the left side, extending from the line of 
dullness at ninth rib, downward about 8 cm., the breadth 
being about half this distance (Fig. 51). In ordinary cases 
the spleen is not to be sought, as its function is not fully known, 
and its recognized abnormalities are confined to malarial and 
congestive fevers, with occasional malignant growths. The 
length of the thorax will be found to vary greatly in different 
people, and, where the ribs come well toward the umbilicus, 
the liver should hardly reach to the lower edge of the ribs, 
except in front, while in the cases of short chest it may extend 
five or more centimeters below the free margin. The left lobe 
extends across the median line for about 6 or 8 cm. (Fig. 51), 
where its limits are not readily discovered by percussion, on 
account of the area of heart dullness. At the right side the 
liver extends down to the tenth intercostal space, and behind 
it reaches to the last rib (Fig. 52) . 

It should be remembered that the lower limits of the 
liver may vary greatly without its being an indication of en- 
largement or disease. In examining this organ, therefore, it 
is well, if any apparent malformation exists, to determine 
by percussion, and mark with a flesh pencil the outline of the 
organ. The exact measurements can then be made and mal- 
position differentiated from hypertrophy. 

Some of the more common causes of malposition are tight 
lacing, pleuritic effusion, congenital and traumatic malforma- 
tions, pericarditis with effusion, and certain abdominal tumors. 
For convenience in treating the normal positions of certain 
organs, the following points should be fixed in mind. 

The sternal notch is on a level with top of the second 
dorsal vertebra or tip of seventh cervical spine. 

The spine of the scapula is on a level with the third dorsal 
spine. 



158 Physical Examination. 

The lower angle of the scapula is on a level with the seventh 
dorsal spine. 

The base of the heart lies at the fourth dorsal spine. 

The apex of the heart lies :at the level of the eighth dorsal 
spine. 

The apex of the lung lies opposite the seventh cervical 
spine and vertebra, and from two to four cm. above the top 
of the sternum. 




Fig. 52. 

Showing the positions of the kidneys, j k, and spleen, h; margin of 
liver, I. The dotted line, e f g, shows the lobar divisions of the lungs. 
Scheube. 

The base of the lung is on the level of the tenth dorsal 
spine. 

The spleen lies on the level of the ninth and eleventh dor- 
sal spines. 

The upper convexity of the liver lies on a level with the 
eighth dorsal spine or slightly above the lower end of the ster- 
num. 



Examination by Auscultation and Percussion. 159 

The nipple usually covers the fourth intercostal space at 
level of sixth spinous process. 

These locations are all referred to the spinous processes of 
the vertebra as fixed points that can always be found. If we 
rub the ball of the thumb firmly down the furrow between the 
erector spinae muscles, the tips of the spinous processes will 
show as pink spots on the skin. The method is recommended 
by Dr. Holden to determine the existence of lateral curvatures. 

In auscultation we have the method of most precise know- 
ledge in diagnosis. By other methods of examination we may 
learn that there is something wrong, but the ear is the supreme 
court to decide the case and tell what that "something" is. 
For purposes of auscultation several instruments have been 
devised, but none better for general use than the binaural 
stethoscope of Dr. Camman, Fig. 17, or the stethoscope devised 
by Dr. Bowles. The unassisted ear is able to do all that is 
required in most cases, as the sounds are equally distinct, but 
the ear cannot be readily applied to all parts of the chest, and 
to attempt it in some cases would be to affect other parts of 
of the sensorium with more profound salutations. It may 
be equally unpleasant for the person being examined and there- 
fore the instrument should be used. 

The stethoscope also enables us to localize sounds closely 
by making a direct course of travel for sound waves. Con- 
sequently, it readily transmits those waves that pass directly 
into its bell or tube, while those waves that are not thrown 
directly in, are either lost or become obscure, so that our at- 
tention is centered on the sounds produced directly beneath. 
The pressure of the aural tips closes the external meatus of the 
ear, so that foreign sounds are entirely eliminated. 

The following points in the use of the instrument should 
be borne in mind : 

1. Apply the instrument to the ears so that the aural tips 
will point downward and inward, thus following the direction of 
the meatus of the ears. 

2. Have just sufficient pressure in the ears to hold the 
instrument steady and make the tips fit perfectly. 

3. Let no foreign material touch against the stethoscope 
at any part of it during use, as friction- vibrations will be set 
up. 



160 Physical Examination. 

4. Press the bell firmly over the spot to be auscultated, so 
that it fits the integument perfectly all around. If the surface 
is uneven the soft rubber bell should be used. 

5. Do not let the fingers move on the instrument while 
holding it in place. 

6. Always apply directly to the skin, as nothing satis- 
factory can be heard through even a thin layer of cloth. 

7. The examiner should keep his own head as nearly erect 
as possible to avoid cerebral congestion from venous constric- 
tion. 

Where the naked ear is used a soft cloth can be interposed 
between it and the subject. 

In listening to the sounds of the mitral and tricuspid valves 
with a stethoscope, it is well, should there be doubt in diagno- 
sis, to place a thin cloth, like a napkin, on the chest, and auscul- 
tate through it. The only sound heard through this will be 
the valvular click — the first sound becoming short and un- 
complicated like the second sound. 

In auscultation continued practice must be given to learn- 
ing normal sounds and their relations. If the examiner knows 
every healthy sound with its variations, he will instantly rec- 
ognize an abnormal one, even if he is not able to clearly state 
or even understand the existing lesion. Some sounds are so 
complicated as to defy experienced surgeons in reading their 
significance. 

The following points are to be studied: 

(a) Muscle-sounds, by placing the stethoscope over a 
muscle like the biceps, during its contraction and relaxation. 

(b) Heart-sounds, by studying the sound at each location 
in the precordial region and along the large arteries. 

(c) Lung-sounds, in every region of the chest. 

(d) Intestinal-sounds, that are caused by the gases of 
fermentation. 

(e) Succession or splashing sounds of fluid in the stomach 
(or chest) , while it contains free gas. 

(/) The "bruit" or hum heard in many cases over the 
large venous trunks, especially of the neck and upper chest 
and over aneurismal sacs. 

A muscle sound is of low pitch and vibratory quality — a 
rapid throbbing as it were. Its character is represented in 
exaggerated form by moistening the end of the thumb and 



Examination by Auscultation and Percussion. 161 

then rubbing it along the surface of a wooden table with a 
fairly rapid movement. The thumb will jump along the 
surface giving a low vibration to the wood. The muscle sound 
is the cause of the peculiar, prolonged "booming" sound of 
the heart during its contraction, and it modifies the valve 
sound of closing to some extent; therefore the directions on 
page 28 should be followed if there is an apparent systolic 
murmur. 

The valve sounds are brief in duration, of high pitch and 
clicking or non-resonant quality. These sounds are confused 
more or less by the muscle sound, by respiration sounds and 
by the vibrations of blood currents both normal and abnormal. 
These abnormal sounds are generally of blowing quality and 
are called murmurs. They will be studied more at length in 
Chapter XIII. The sounds of the normal heart must be patient- 
ly studied with the stethoscope until its every peculiarity is 
familiar; its rhythm, its force, its various valve sounds, its 
points of clearest differentiation of complex sounds and its 
transmission of sounds, the relation of the pulse in various 
localities to heart inpact, etc. It is only by a thorough ac- 
quaintance with normal conditions that the abnormal can be 
recognized. 

There will be found frequent cases of arterial and venous 
murmurs or humming sounds that will be likely to be mistaken 
for heart murmurs. These have a location over the larger 
blood vessels and the sound is continuous rather than inter- 
mittent, if of venous origin, and if arterial, the sound is usually 
not heard at the heart, but at some point where a large trunk 
makes a sharp turn or is narrowed by pressure of adjacent 
structures, as in the subclavian artery. The venous murmur 
may vary from a low hum to a whistling sound. The jugular 
vein is the spot where the venous hum is most frequently 
heard, and in many cases a hum can be produced by an uneven 
pres.sure of the stethoscope, making a slight constriction in the 
calibre of the vessel. Turning the face of the subject to one 
side will sometimes produce a hum on the opposite side. This 
sound has been called by some writers an anaemic hum, but 
its cause can hardly be assigned directly to the quality or 
quantity of the blood. Anaemia might be a factor in the pro- 
duction of the sound by causing a softening of the tissues 
supporting the vessel, and the watery venous blood may be 



162 Physical Examination. 

sonorous to a larger extent than arterial blood, as taught by 
Walshe, but the direct cause must be the unevenness of the 
calibre of vessels, through which blood must be flowing at a 
speed bearing some relation to the size of their lumena. 

Arterial murmurs may be due to roughness of the inner 
coat due to inflammations or vegetations, sacculations, or 
pressures. These causes would produce systolic murmurs that 
would be loudest over the site where they are produced. From 
similar causes murmurs may be produced in the cavity of the 
heart itself. Another class of murmurs is found in extremely 
nervous people, excessive tobacco users and overtrained ath- 
letes. It is due to irregular muscular action of the heart, 
with consequent imperfect closing of the valves, and is there- 
fore systolic and heard more commonly over the base of the 
heart. These murmurs are not constant, and do not frequently, 
if ever, exist with benign hypertrophy. 

Heart murmurs due to dilatation of the cavities from 
anaemia do occur, and in those cases it is difficult to decide 
whether there is aortic obstruction or a simple dynamic mur- 
mur. In the first case, however, we would find a powerful 
heart impulse from hypertrophy, while in the second there 
would be a feeble impulse from the imperfect contractions. 
At times 'the respiratory sounds may confuse the heait sounds 
by the air being driven out of a portion of the lung by the heart 
impulse, giving rise to a sound that may be mistaken for a 
heart murmur. This sound would be systolic and not heard at 
the apex. 

It is well, then, in examination, to apply the stethoscope to 
the apex of the heart first and then over the base, listening 
carefully to the valvular sounds and asking the subject to 
suspend respiration in expiration for a moment if any abnor- 
mal sound is heard. Then listen over the carotid and sub- 
clavian arteries on each side. If a humming sound is heard 
that cannot be understood, let the subject take some of the 
gentler strength tests, and after a slight acceleration of the 
pulse listen again, and so proceed until he understands the 
case. The case may not be one to be determined in a few 
minutes or days. 



The Significance of Certain Physical Signs. 163 



CHAPTER XIII. 

THE SIGNIFICANCE OF CERTAIN PHYSICAL SIGNS. 

In listening to the sounds of the lungs we must also have a 
fixed idea of the normal before endeavoring to study abnormal 
sounds. In perfect health the normal vesicular murmur of the 
lungs varies within quite wide limits of force, pitch, quality 
and duration, due to the difference in thickness of the chest 
wall and the activity of respiration in different individuals, but 
the general character of the sounds remains the same. 

This sound has been likened to the faint rustling of dry 
leaves or straw, but the only description that is of help to a 
student is the one that he makes to himself by continuous use 
of the stethoscope and naked ear applied to the chest. 

The following point may be borne in mind as helpful in 
examination : 

1st. The murmur is shorter in expiration than inspiration, 
and in some cases the murmur is entirely suspended during 
expiration. 

2d. The murmur is harsher over the region of the larger 
bronchial tubes, becoming milder as we pass downward to the 
base. 

3d. The heart sounds will tend to confuse the lung sounds 
in the front of the left lung, but only in a few cases is it diffi- 
cult to hear only the sounds you search for. 

4th. The sounds of bronchial breathing are heard in simple, 
uncomplicated form, over the trachea and upper sternal region* 

5th. The quality of bronchial respiration sound is tubular 
and harsh; the pitch is high. 

6th. The expiration sound is longer than inspiration in the 
region of pure bronchial breathing. 

7th. Vesicular or fine respiratory murmur is heard to the 
lower margin of the lung tissue. 

8th. If the murmur ends abruptly at any point above the 
natural border of the lung, and the murmur is normal, suspect 
an effusion into the chest cavity. 

9th. Normal flatness may begin as high as the sixth rib on 
the right side, and at the seventh on the left. 



164 Physical Examination. 

The abnormal respiratory sounds are called rales. They 
are in general of the bronchial type rather than the vesicular. 
The sounds may be dry and rasping as when the tubes are 
contracted by an inflammation at the initial stage or a spasm 
of the muscular fibres of their walls or by local pressure. The 
sounds are called moist when the tubes are obstructed by more 
or less fluid. These rales may be so loud as to obscure the 
vesicular murmur. 

The crepitant rale is a fine, dry, crackling sound, heard in 
the last part of inspiration in pneumonia and phthisis, and has 
been compared to "the sound produced by rubbing a small 
wisp of hair between the thumb and finger near the ear," 
"pulling postage stamps apart," etc. 

The subcrepitant rale is heard in bronchitis, pneumonia, 
oedema of the lungs, phthisis, etc. It is a fine, moist, bubbling 
sound, heard in both inspiration and expiration. 

Coarse bronchial rales are heard in bronchitis, phthisis, etc., 
and are caused by mucous interrupting the flow of air. These 
rales may be so loud as to be heard without applying the ear to 
the chest and if the mucous is very dry a whistling sound will 
be produced. 

Gurgling rales are sometimes heard, especially if the subject 
is very weak and cannot expel thin mucous from the larger 
tubes or if there is a cavity in the lung from tubercular de- 
generation. 

Aside from the respiratory sounds the vocal resonance is of 
importance in determining the condition of the lungs. 

1. The laryngeal voice is heard over the trachea and large 
bronchial passages, while in the general area of the chest the 
sound is modified and softened until the vocal expression is lost 
except over the right bronchus, and, in thin persons, the left. 

2. This tone with "far-away" quality is known as the 
pulmonary resonance. It corresponds to the vocal fremitus of 
palpation. 

3. Increased resonance indicates some consolidation of the 
king without closure of the bronchial tubes, cavities, pleuritic 
adhesions or compressed lung tissues from effusions. 

4. Diminished resonance is due to obstruction of the 
bronchi or a layer of fluid between the lung and chest wall. 

5. Suppressed resonance is caused by large effusion in the 
pleural sac, with compression of the lung or new growths. 



The Significance of Certain Physical Signs. 165 

6. Bronchophony or a development of the bronchial type 
of resonance in unusual locations indicates a condensation or 
hardening of lung tissue or cavities. 

7. Amphoric resonance indicates very large cavities or 
pneumohydrothorax. The quality of the sound is musical and 
metallic; the pitch and the resonance hollow and without 
articulation. 

8. Whispered resonance is found in as many forms as 
vocal resonance, and its modifications are due to the same 
causes. It is a more delicate test of slight consolidation and 
hence should be thoroughly studied. In normal cases it pre- 
sents a soft blowing sound at the. upper part of the chest only, 
where consolidation usually begins. 

9. A cough resonance is helpful at times in securing cumu- 
lative evidence of a condition suspected from other sources of 
information. This is specially true of the diagnosis of cavities. 

In considering the sounds of the heart it is well to bear in 
mind the anatomical features of the heart and the course of 
the blood as it passes into the heart and through it to the 
aorta. The blood from the lower parts of the body is con- 
ducted by the inferior vena cava to a point near the heart 
where it meets the current brought from the upper parts by 
the superior vena cava, and unites with it to form the innomi- 
nate vein which empties into the right auricle after a length of 
30 to 40 mm. There is no valve at the mouth of this vein, but 
blood can flow backward through it under pressure. The 
right auricle is a pouch-like sac with only a small amount of 
muscular fibre in its wall. This auricle acts as a reservoir of 
a fairly steady current whose contents are discharged at inter- 
vals into the ventricle or muscular compartment directly below 
it. This act of discharge is easy during the period of diastole 
or relaxation of the ventricular muscle, and is accomplished by 
gravity and the contraction of the auricular walls. When the 
ventricle is distended with blood the muscular walls begin to 
contract and the blood is forced toward the two openings, the 
pulmonary artery and the auriculo- ventricular passage, but 
this latter is fringed by the tricuspid valve which is quickly 
closed by the current and the blood sent on to the lungs. At 
the opening of the ventricle into the pulmonary artery there is 
a valve composed of three semi-lunar flaps of pocket shape, 



166 Physical Examination. 

which prevents a return current after the contraction or systole 
has ceased. 

After passing through the pulmonary tissue the blood comes 
back to the left side of the heart and enters the left auricle by 
the pulmonary veins which are unguarded by valves to prevent 
regurgitation. The right auricle is very similar to the left in 
function and anatomical character. From it the blood passes 
down into the left ventricle during its period of diastole, and 
is prevented from flowing back during the powerful contrac- 
tion of the ventricle by the mitral or bicuspid valve. This 
closure of the auricular orifice leaves only the opening of the 
aorta by which the blood must be driven out, and which then 
conducts it to the general circulation. At the aortic opening 
are located semilunar valves to retain the blood that has once 
passed into the arterial trunk, so that it cannot flow back and 
refill the ventricle during its period of receptivity. 

It is clear, then, that in normal heart action we must have 
four valvular sounds, and these must all originate at points at 
no great distance from each other. In fact a circle of 25 mm. 
radius drawn from a center at the sternal end of the fourth 
costal cartilage on the left will cover the four valves. There 
are points, 'however, where each sound is heard more plainly, 
and these are for the mitral valve at the apex of heart ; for the 
aortic valves at second intercostal space just at the right of 
the sternum, and over the right common carotid artery; for 
the tricuspid valve at middle of the sternum at the level of the 
nipple; for the pulmonary valve at the left of the sternum in 
the second intercostal space. The mitral and tricuspid sounds 
must be at the beginning of the systole, and are called the first 
sound of the heart, while the semilunar closings will be at the 
end of the systole, and are called the second sound of the heart. 
The first two sounds are synchronous and also the last two. 

The first sounds are prolonged by the muscle vibration into 
a full booming sound, while the second sounds are short and 
clicking. Foster illustrates the difference by pronouncing the 
words loob-dub in the same relative time at the heart sounds. 
Between the second and first sounds is an interval that is 
essentially two-fifths of the time required for a complete cycle 
of heart action. This is called the period of rest. The follow- 
ing table is a summary of normal heart sounds. 



The Significance of Certain Physical Signs. 



167 





Sounds. 


1. 


Muscular. 


2. 


Mitral 




valve. 


3. 


Aortic 




valve. 


4. 


Tricuspid 
valve. 


5. 


Pulmonary 
valve. 



NORMAL HEART-SOUNDS. 
Location. 



Within boundary limits of 
heart or precordial area. 

Behind the 3rd left intercos- 
tal space and 4th costal 
cartilage about 20 mm. 
from sternum. 

Behind the left edge of the 
sternum at the level of the 
3rd intercostal space. 



Behind the sternum at the 
level of the 4th costal car- 
tilages. 

Behind the junction of the 
3rd costal cartilage with 
the sternum on the left. 
Above in front of the 
aortic valve. 



Where Heard 



Heard best at apex and 
just above. 

Just above apex beat 
and at 3rd intercostal 
space on left of ster- 
num. 

At 2nd intercostal space 
on right of sternum 
and over the common 
carotid arteries. 

At lower end of the 
sternum above the 
ensiform cartilage. 

At 2nd intercostal space 
to left of the sternum. 



The boundary limits of the heart as given by Holden are 
as follows: 

For the base draw a horizontal line over the third costal 
cartilages extending 12 mm. to the right and 25 mm. to the 
left of the sternum. For the apex draw a perpendicular line 
50 mm. long downward from the left nipple and from its lower 
extremity draw a horizontal line 25 mm. to the right, which 
will bring the pencil over the apex to the heart in the fifth 
intercostal space. The nipple is usually located over the fourth 
intercostal space. From the apex draw a curve to the end of 
the sternum, and continue it up more sharply to the right edge 
of the sternum, and continue it upward to the right end of the 
base line by a gentle curve. The left side will be marked by 
a curve of about 200 mm. radius extending from the left end 
of the base line to the apex (see Fig. 49) . 

The part of the heart not covered by lung tissue is incon- 
siderable, and is described by Dr. Latham as being outlined 
roughly by a circle of 25 mm. radius drawn from a center half 
way between the nipple and lower end of the sternum (see 
Fig. 51). 

Abnormal heart sounds are usually called murmurs, and 
result from four causes : 

1. The failure of valves to perfectly hold the blood from 
leaking through. 



168 Physical Examination. 

2. The narrowness of the opening through which the 
blood is forced into a tube of larger caliber. 

3. Friction of the external surface of the heart against an 
inflamed pericardium. 

4. Friction or endocardium from vegetations. 

The first cause may be due to active inflammation of the 
valves from endocarditis, etc., that produces vegetations or 
uneven thickening of the valves and therefore imperfect closure, 
or the walls of the heart may become so distended as to pre- 
vent perfect coaptation of the valves. Other causes also may 
produce imperfect closure. 

The second cause usually depends on inflammation that has 
caused a deposit of fibrous tissue around the orifice affected. 
The third cause is more often the result of an injury or 
strain, and is found in some cases after violent exercise. 
The fourth is found after fevers, rheumatism, etc. 
The character of these abnormal endocardial sounds is hiss- 
ing or blowing, and for this reason they are called by some 
writers "bellows murmurs," while the friction sound is more 
squeaking or grazing in its quality, and can frequently be diag- 
nosed by the fremitus discovered by palpation. 

The pitch varies in all the sounds from a low, gentle mur- 
mur to a high whistling note — the pitch giving us some idea as 
to the size of the opening ; for if the sound be caused by a stream 
forced through a small aperture the pitch will he higher — the 
surfaces set in vibration being much shorter than in the large 
opening. 

The most common heart lesion is a failure of the mitral 
valve to perfectly close the left auriculo- ventricular passage. 
This is called mitral insufficiency. It is plain that any fault in 
the closing of this valve would permit the blood to flow back 
into the left auricle during systole, and that this would cause 
increased pressure in the auricle and pulmonary veins, thus 
interfering with respiration and distending the auricle. A s 
the heart contraction forces blood into the aortic arch, there is 
an effort toward straightening the aorta from the pressure, and 
this brings the apex of the heart against the chest wall at about 
the fifth intercostal space. This brings a continuous vibratory 
medium of solid tissue from the point of vibration to the exter- 
nal surface where we may receive it by the ear or stethoscope. 
We also find that the sound is carried to the left axillary region 



The Significance of Certain Physical Signs. 



169 



along the fifth or sixth rib. The sound is heard over the val- 
vular region at the base of the heart but without characteristic 
qualities. The time of the murmur is during the systole, and 
hence it begins with the valvular click of the^ first sound and 
ends with the second valve closing at the aorta which gives the 
second sound. 

If the heart sounds are so deranged that it is difficult to 
decide which is the first sound, it may be determined by re- 
membering that it is synchronous with the impact of the apex 
against the chest wall, and also with the pulse wave in the 
carotid arteries. The following sphygmogram shows the 
typical disturbance of arterial pressure in mitral regurgitation 
(see Fig. 53). 

The curve is not abrupt in the systole, 
and the pressure is not sustained to the 
dicrotic wave. If the systole is very ener- 
getic the pulse would be large but soft. 
The rhythm is irregular. Fig. 54 shows 
mitral regurgitation with slight aortic in- 
sufficiency. In order to un- 
derstand the meaning of 
these curves, let us study 
briefly the normal pulse trac- 
ing (Fig. 55). "All scien- 
tific investigators agree that the line A represents the cardiac 
contraction, the impulse being conveyed to the 
needle through the arteries in the same manner 
that the impulse is given to the last marble in 
a row of marbles by striking the first marble 
in the row a quick blow, the difference being 
that the row of marbles does not advance, while the blood 
current does. This ascent we will call the systolic wave. 

"The arteries thus suddenly filled begin immediately by 
virtue of their elasticity to contract and the needle descends 
to the point B. Next we have a wave, the cause of which is 
not definitely settled. It is generally believed that the wave 
B-C, called the tidal wave, is due to a rebound of the blood 
from the terminal vessels or capillaries, for the following reasons: 
"The tidal wave is more perceptible nearer the capillaries. 
"The base of tidal wave approaches the systolic line and 
systolic apex the farther the tracing is taken from the heart. 





Fig. 53. 



Fig. 54. 




Fig. 55. 





170 Physical Examination. 

"Sweating renders the tidal wave less perceptible and the 
base nearer the dicrotic notch. 

"From C the artery again contracts till the needle reaches 
point D. The rise at D is generally conceded to be due to the 
rebound of blood from the closed aortic valves and is usually 
termed the dicrotic wave. The remainder of the cycle repre- 
sents the diastole or rest of the heart."* 

Fig. 56 shows a normal pulse of 
> high tension and Fig. 57 a normal 
Fig. 56. pulse of low tension. The lesion Fig. 57. 
that stands second in frequency is obstruction at the aortic 
orifice — any narrowing of this opening that makes its caliber 
less than that of the aorta will produce a murmur and tend to 
increase the work of the ventricle with resulting hypertrophy. 
It obviouvsly does not menace life and health to the same extent 
as mitral insufficiency. The sound being produced by the 
current forced out by the contraction of the ventricle it must 
be synchronous with the systole and end with the second sound 
of the heart. Its location being at the base of the heart, we 
would expect to find the sound clearest at the beginning of the 
aorta. It is in fact heard most distinctly over the sternum, at 
level of the second rib or just to the right of the sternum, and 
is also heard over all the large arterial trunks of the upper 
thorax and neck. It is called aortic stenosis. 

#A ^ Fig. 58 illustrates the typical pulse tracing 

\j ^^/ w in this lesion. The systolic curve is not abrupt 
Fig. 58. nor high, but the pressure is well sustained past 
the dicrotic notch. The pulse is small and usually regular. 

The third lesion in frequency is a regurgitation of blood 
through the semilunar valves from the aorta into the left ven- 
tricle. Evidently this can only occur during the diastole of 
the heart. It should be heard in the same locations as the 
murmur of aortic stenosis, and also down along the sternum. 
The lesion is termed aortic insufficiency. 

The interference with the pulse is. shown by Fig. 
59. Its characteristics are marked. The systolic 
curve is high and abrupt. The fall is abrupt. The 
Fig. 59 dicrotic wave is small. The pulse is quick and strong 
—the "bullet" pulse. 

*See an article on "Use of the Sphygmograph," by Dr. J. G. Smith, 
in Annual Report of the American Association for Advancement of 
Physical Education, 1888. 




The Significance of Certain Physical Signs. 171 

The fourth lesion producing a characteristic sound is mitral 
obstruction due to stenosis of the left auriculo-ventricular 
passage. This would interfere with the passage of blood from 
the auricle to the ventricle in the period of diastole. The 
murmur being started during the stage of auricular contrac- 
tion and ending with the beginning of the first sound; it is 
called presystolic. It is heard over the mitral valve and at the 
apex of the heart, but is not transmitted over a large area. 
This lesion leads to much pulmonary disturbance on account 
of the increased blood pressure in the lungs. 

The fifth lesion is obstruction of the pulmonary orifice from 
stenosis. This would place extra work on the right ventricle, 
which hypertrophies by natural accommodation. The murmur 
must be systolic and heard over the second cartilage to left of 
the sternum. It is prolonged upward and to left of the ster- 
num for only a short distance as the artery soon divides into 
small branches to ramify through the lungs. 

The sixth lesion is a regurgitation through the tricuspid 
valves due to insufficiency of the closure. It is systolic and 
causes great increase of venous pressure by the current forced 
back into the auricle and through it into the venous trunks 
causing a venous pulse. It is heard at junction of ensiform 
cartilage with the sternum and to the apex. 

The seventh lesion is an obstruction of the right auriculo- 
ventricular opening by narrowing, and hence the murmur 
must be presystolic. 

It is heard over the middle of the sternum at level of fourth 
cartilage and is not transmitted except to a slight extent down- 
ward to the end of sternum. It is called tricuspid stenosis. 

The eighth lesion is a regurgitation through the valves 
(semilunar) at the opening of the pulmonary artery, and is 
termed pulmonary insufficiency. It tends to enlargement of 
the right ventricle, and interferes with the pulmonary circu- 
lation and aeration of blood. In time it must be diastolic, and 
is heard at the region of the second left costal cartilage. The 
sound is carried along the sternum faintly. 

A murmur is transmitted in general, by the blood, and 
hence in the direction of the current. 



172 



Physical Examination. 



TABLE OF ABNORMAL HEART SOUNDS. 



Condition . 

1. Mitral regurg. 

2. Aortic obstruct. 

3. " regurg. 

4. Mitral obstruct. 

5. Pulmon obstruct 

6. Tricusp. regurg. 

7. " obstruct. 

8. Pulmon. regurg. 



Heart Sound. 
1st. sound. 



After 2d sound, 
1st. sound. 

After 2d sound. 
With 2d sound. 



Heart Action. 
Systolic. 



Diastolic. 



Systolic. 



Diastolic. 



Where Heard. 

Mitral area and 
apex. 

2d. rt. cost, car- 
til at sternum. 

2d. rt. cost, car- 
til, at sternum. 

Mit.al area and 
apex. 

2d. left cost, car- 
tilage. 

Just above ensi- 
form cart. 

Sternum at head 
of 4th rib. 

2d left costal car- 
tilage. 



Transmitted. 

Along 6th rib to 
axilla. 

To top of ster- 
num and ar- 
terial trunks. 

Down along 
sternum. 

Not transmit'd 



Up a short dist. 
ends abruptly 

Down a short 
distance. 

Not transmit'd 



Up a short dis- 
tance. 



Lesion. 

Mitral ins 
fiency. 

Aortic 

steno 

Aortic 
insufHcien 

Mitral 

steno; 

Pulmonale 
steno; 

Tricuspid 
insufficien 

Tricuspid 
stenoj 

Pulmonar\ 
insufficieni 



If these lesions be tabulated in the order of their frequency- 
it will be observed at once that the left side of the heart is 
most frequently affected — all possible abnormalities having 
representation before the most frequent murmur of the right 
side. The reason for this is clear when we consider the vastly 
greater extent of tissues to be supplied by the left side of the 
heart compared with the pulmonary circulation supplied by the 
right. 

The exocardial murmur is due to the movement of the 
heart rubbing two inflamed and roughened surfaces together. 
The pitch is usually high and quality squeaking. It has no 
connection with the valve sounds in time or location — is not 
transmitted in any particular direction and if loud, may be felt 
as a fremitus at the apex beat. It has no influence on the pulse 
curve. 



The Pulse of Mitral regurgitation : 

(a) Compensated, is soft and often large. 

(b) Uncompensated, is soft and short (celer) . 

" " " " stenosis is small and soft (sometimes frequent and 

often irregular) . 

" " " Aortic regurgitation is quick, large, "shotty pulse" 

(and regular) . 

" " " " stenosis is small and long (tardus). 

" " " Tricuspid regurgitation is venous. 



The Significance of Certain Physical Signs. 173 

There is a normal venous pulse. In time it precedes the 
arterial pulse, and may be said to alternate with it. It is 
caused by the auricular systole and the consequent stopping of 
the free current toward the heart. 

The abnormal venous pulse is discovered most easily at the 
lower part of the jugular vein, and is synchronous with the 
arterial pulse, being due to the same cause, namely, the systole 
of the ventricles. This indirect current can be forced into the 
veins only when there is insufficiency of the tricuspid valve. 



174 Prescription of Exercise. 



CHAPTER XIV. 



PRESCRIPTION OF EXERCISE. 



The main object of a physical examination is to learn as 
many facts concerning the physical needs and tendencies of the 
subject as possible in order to be able to advise him properly 
regarding his exercise and personal hygiene. Without being 
able to give exactly the measures of a perfect man or woman 
we must have a standard of form and development that is 
derived from a knowledge of anatomy and experience in obser- 
ing the individuals that present the highest evidence of perfect 
health and power. We learn also in a negative way by a study 
of pathological cases. The persons of impaired health can 
usually be so classified in groups with common symptoms that 
certain physical signs will be found common to nearly all in the 
group. Then by a study of the history of these cases we can 
judge with some correctness whether the physical sign stands 
in the relation of cause or effect to the abnormal symptoms. 
For instance, if we group together all cases of organic lung 
diseases such as tuberculosis, chronic bronchitis, recurrent 
attacks of pneumonia, pulmonary congestion, emphysema, etc., 
and find that a very large per cent, of the cases have in common 
poorly developed respiratory muscles, flat chests, sagging shoul- 
ders, etc., with no other common feature, we may properly con- 
clude that a chest of this type is not favorable for the healthy 
activity of lung tissue and in no sense is it a model toward which 
we should endeavor to conform the flexible chests of our people. 

But our inference might be very far from truth and untrust- 
worthy if we did not also approach the subject from a different 
line of study and reach the opinion in a positive way. We do 
this by grouping the individuals that have proved their ability 
for enduring prolonged mental and physical strain, the superior 
individuals of society, like Bismarck, Gladstone, Greeley, 
Webster, etc. If we find in this group the physical comform- 
ity of chest exactly opposite to our other group, we have added 
to our knowledge of what should be avoided, a type that may 
wiselv be followed. 



Prescription of Exercise. 175 

It is often a question how far the aesthetic sense may guide 
us in deciding as to a physical standard. The eye will ordina- 
rily be pleased with the form that has scientific perfection. A 
well rounded and developed body is more pleasing than a lax, 
untrained one, but there may be sentimental and unjust stand- 
ards of criticism, the result of faulty training in youth, that 
bias even our judgments of beauty. 

This is seen everywhere in the world of fashion. A head 
of hair that is considered beautiful and becoming one season 
must be bleached or dyed to some other color in order to be 
"perfectly lovely" the next. This depraved taste that ap- 
proves of a pale face and crooked, spine in a student, and a 
narrow waist with constricted chest and pelvic displacements 
in a woman, must be educated up to the scientific and artistic 
standard. We must show in the gymnasiums that increased 
health means not only increased ability, but increased beauty, 
and that health is only a correct balance of functional activities. 
It cannot exist in perfection if one part is under-developed or 
over-developed. 

This brings us to the first point in prescription. If we dis- 
cover an abnormality of shape due to extraneous causes we 
should first prescribe the removal of these causes when pos- 
sible. To forget this would be to give medicine to counteract 
a poison while permitting the patient to ingest more of the 
deadly substance. In work with both sexes the matter of dress 
should be inquired into where we find any suspicious abnormal- 
ity of shape. This is especially true of constrictions of the 
trunk. Boys will often wear a belt in imitation of some noted 
"slugger" or local "tough," or for other reasons known only 
to themselves. The injurious effects are the same as those 
seen in the case of corset-afflicted women — weak lumbar mus- 
cles, narrow loins, pendent abdomen, varicose veins, costal 
respiration, digestive ailments, etc. 

The muscular weakness cannot be cured while circulation 
is impeded by pressure on the fibres; the narrow waist cannot 
be brought out into correct outline, to give room for a proper 
location of the digestive organs, that would relieve the supra 
pubic distention, while every force is crowding them down into 
the pelvis. 

The respiratory act should be unimpeded or imperfect 
oxidation will result and this means virtually an enforced 



176 Prescription of Exercise. 

vitiated atmosphere. A reduction of waist-girth by 50 mm. is 
shown by Dr. Sargent to reduce the lung capacity twenty per 
cent. A number of persons with an ever age lung capacity of 
2.70 litres, and waist girth of 710 mm. were found to have a 
lung capacity of only 2. 15 litres when the waist girth was re- 
duced to 660 mm. 

A reduction of the oxygen in the air by diluting it with 
nitrogen or carbon dioxide to the extent of twenty per cent, would 
soon be disastrous to active life. Again, constriction of the 
waist calls for an entirely artificial method of respiration as 
has been conclusively shown by Dr. Kellogg, through whose 
courtesy the following illustrations of normal and abnormal 
respiration are given on page 177. 

After looking at these illustrations, that explain themselves, 
two questions might be suggested' by any person not fully 
acquainted with Anatomy and Physiology: First. Does not the 
amplification of the costal curves during compression show that 
the respiration act is fairly complete — one set of muscles acting 
w r hen the other is impeded? This view has been presented in 
articles by Dr. Mays, to which reference has already been made, 
who attempts to show that this method of breathing may tend 
to prevent tuberculosis by causing a better action of the apices 
of the lungs where the disease usually locates. The only sup- 
port brought to this theory was the fact that more men than 
women die of pulmonary tuberculosis., but when we remember 
that this disease is largely due to climatic influences of which 
wide and sudden variations are the chief features, and that 
men are more exposed to these variations than women, the 
argument seems worthless. 

But even if we concede a possible safeguard against tuber- 
culosis in tight lacing we must still look upon it as a case where 
the remedy is worse than the disease, or a disguised blessing 
of the kind described by "Josh Billings," who remarked that 
"tight boots are a blessing, inasmuch as they cause a man to 
forget all his other miseries." 

Second, If costal respiration is prejudicial to health why do 
we not have a larger death-rate from acute lung diseases and 
other diseases directly traceable to interference with respira- 
tion? 



Plate I. 




Abdominal. 




Costal. Abdominal. 

Fig. 2. Civilized Woman (Unmarried, age 33 years), 




Costal. 



Abdominal. 



Fig. 3. Chinese Woman. 




Costal. Abdominal. 

Fig. 4. Indian Man (Chickas4w). 




Costal. Abdominal. 

Fig. 5. Indian Woman (Chickasaw). 




Costal. Abdominal. 

Fig. 6. Chippeway Indian Woman. 



178 Prescription of Exercise. 

The reply is ready that the impaired activity of one organ 
rarely gives evidence in physical signs of its abnormality. 
Even as sensitive an organ as the brain may disclose its dis- 
ordered function, not by pain in the head, but by the abnor- 
mal secretion in some remote organ; or a disease of the kidney 
be discovered by its causing an organic change in the heart. 
The lungs are ordinarily capable of enduring great hardship. 
Their flexibility enables them to conform to any shape of the 
thorax or to be compressed for a long time by a pleuritic effu- 
sion, or other cause without permanent injury, as is frequently 
seen in cases of extreme kyphosis. According to the statistics 
of the New York Mutual Life Insurance Co., consumptives 
average one and a half inches less in chest girth than non- 
consumptives. 

But meanwhile how fare the organs that are dependent on 
good blood? The brain cannot act well from the instant un- 
oxidized blood flows in to supply it. Lowered vitality is the 
result with a yielding to acute diseases of every kind. Many 
a death is recorded as due to typhoid fever, peritonitis, malaria, 
etc., that is really due to a deficient respiration when the system 
requires the most active oxidation. The respiratory power 
is recognized as of the highest importance in all acute diseases. 

The same care must be exercised in judging whether or not 
a bad form is due to faulty habits of posture. If the respira- 
tion is checked by a position that brings a bend in the trunk 
with a depression across the upper part of the abdomen, as is 
the case when one slides forward in his seat until the sacrum 
instead of the ischia bears the weight of the body, the same ill 
results will be found that are noticed in tight lacing. The 
horizontal depression due to the above cause will sometimes be 
found as high as the fifth rib, causing the "creased chest," 
and we can readily understand the interference with circulation 
that must exist in such cases. In all there will be more or less 
disturbance of the hepatic function, impaired digestion, consti- 
pation and atrophy of the lumbar muscles. Correct "form" 
while exercising is of special importance m these cases. 

Attention was many years ago directed to the importance 
of the pelvic position, but comparatively few have undertaken 
a thorough study of what may be considered a normal tipping. 
If we take as the original position the horizontal, we may meas- 
ure by degrees of an angle the departure of the pelvis from 



Prescription of Exercise. 



179 



this initial position, and thus record what is called the obliq- 
uity of the pelvis. An instrument. Fig. 37, for this purpose 
was first devised by Dr. Mosher and put into practical use." 
In the article quoted she gives the results of measuring forty- 
one cases, tw^enty-three of which represented abnormal condi- 
tions, while eighteen represented perfectly 
healthy women. The table here reproduced 
shows that in every abnormal case the angle 
of obliquity was as small as thirty-four de- 
grees, and in only one case was it over thirty- 
one degrees; while among the healthy women 
examined in no case was the angle less than 
thirty-seven degrees, and in nine it was as 
large as forty degrees. The averages were 
28.3° and 40.1°, a suggestive variation. 

Dr. R. L. Dickinson of Brooklyn has 
studied the obliquity of the pelvis and his 
records coincide very closely with those taken 
by Dr. Mosher. Dr. J. H. Kellogg has also 
studied the importance of the pelvic obliqu- 
ity, and has for many years laid great stress 
upon the necessity of such posture as shall 
secure a large obliquity. The outline of Fig. 
60 is taken from a drawing made by him to 
illustrate normal healthy poise. The author 
has applied the lines representing the angu- 
lar tip of the pelvis. 

In early life the spine is essentially straight, the vertebrae 
being so related to each other that they represent a slight 
curve with a concavity toward the anterior of the body. At 
this time the pelvis has its brim located essentially at right 
angles to the line of the verebras, the legs are drawn up and 
a comparative shortness of the muscles running from the ante- 
rior trunk to the thigh results. When the child begins to stand 
erect the leg must be extended from the trunk, which causes a 
stretching of the anterior groups of muscles, with a consequent 
increased pull upon the other attachments. The rectus femoris 
muscles attached to the anterior superior spinous process of 
the ilium will tend to powerfully tilt the pelvis down in front, 




Fig. 60. 



* New York Journal of Gynaecology and Obstetrics, Nov., 1893 



180 Prescription of Exercise. 

while the iliacus interims and the psoas magnus will act in the 
same manner, both running over the ramus of the pubic bone. 
While the young animal is creeping the weight of the abdomi- 
nal organs is supported by the mesentery and the abdominal 
wall. When it assumes the erect position the weight is no lon- 
ger largely supported by the abdominal wall, but must depend 
upon the mesentery and the floor of the abdominal cavity which 
will now be formed by the bony structure forming the pubic 
arch. If now the normal process in development of tilting the 
pelvis downward so as to form this solid support for the abdom- 
inal organs is arrested by any process, either rachitic or pos- 
tural, the result will be that the floor of the abdomen will be the 
soft organs contained within the true pelvis, the pubic arch 
taking a position corresponding more nearly to the soft abdom- 
inal wall and forming a lateral support rather than a foundation. 
The hygienic result of this abnormal position will be obvious, 
and if we bear in mind that the hemorrhoidal veins are not 
supplied with valves, we will understand that the position of 
the pelvic bones is of high importance in both men and women. 

The muscular condition of the Joins and abdominal wall can 
tell us much about the digestion and nutritive powers. If these 
muscles are weak we must point out the fact with emphasis 
and order such exercises as shall tend to give strength and 
activity to them. The small size of a man's biceps or gastroc- 
nemius often troubles him when his real anxiety should be re- 
garding his erector spinae or rectus abdominalis. A person's 
arm will always be large enough for the ordinary demands of 
life upon it — his heart may not be ; his leg will always be strong 
enough to fill every requirement — his stomach may fail utterly. 
A man may have life and fair health with complete loss of 
some 'muscles, while others act at the seat of life itself. 

A class of cases will come under the care of the instructors 
in the gymnasiums of schools and colleges that will be rarely 
met by the directors of other gymnasiums; a set of boys and 
girls who have been overworked mentally and underworked 
physically, until the nervous side of their lives is far in the 
ascendant. The whole idea of their physical exercise has 
become repulsive to them because their muscular tissue is so 
weak that any fair activity begets great weariness, and some- 
times even lameness. Brain work is easy for them because it 
has become the habit of their lives; they can generally accom- 



Prescription of Exercise. 181 

plish great feats in the way of bearing severe strains of short 
duration, both mental and physical. They can sit up all night 
preparing for an examination, and the next day are bright and 
ready for good work, or, at the time of physical examination 
they show a surprisingly high record in strength tests, but 
come in the next day to tell of a strained back or lame shoulder 
as the result of their lifting. They make good athletes, but 
are continually getting over-trained. They invariably do too 
much. 

Is gymnastic work advisable for such persons ? An affirma- 
tive answer can only be given when there is to be personal 
supervision of the work. The boy of high nervous organiza- 
tion needs exercise quite as much as one who has no tendency 
to abnormal nerve activity, but it must be of a different char- 
acter, for the results sought are dissimilar. The nervous per- 
son does not live enough in his muscles. His habit is to make 
excursions out into his extremities, and after stirring them 
up and making every tissue tingle he retires, to leave every 
muscle exhausted and every energy depleted. The exercise 
prescribed for these cases, and enforced by personal supervis- 
ion, must be light and continued over a long period of each 
day. To satisfy the mental requirement of the case the work 
must be made attractive, either as a game or a personal con- 
test between individuals. In a few cases such an interest in 
the physical welfare can be excited in the subject as to take 
the place of this mental interest that is stimulated by games, 
and a person will do routine work that is laid out simply from 
the enjoyment that he gets from visible improvement. 

Athletic work, on the other hand, is too stimulating to the 
nerve centers to be advisable for such cases. The excitement 
of contests will leave a person exhausted, for it will continually 
lead him to over-exertion. This objection does not apply 
to those contests where skill rather than great strength is the 
source of excellence. 

Many of these persons, if uncared for in the gymnasium, 
would shortly fall into the hands of a physician as typical cases 
of neurasthenia, and rest must often be prescribed instead of 
exercise. The effect of sunlight on these neurasthenic cases 
is almost always favorable, and consequently outdoor work 
should be prescribed in preference to indoor work. 



182 Prescription of Exercise. 

In marked contrast to the cases mentioned the athlete may 
be placed. Advice in regard to exercise will be sought and 
such exercise must be prescribed as will tend to secure a de- 
velopment of the muscles that are least used in the particular 
form of exercise in which the athlete engages. Again, after 
a severe course of training for any athletic event, many cases 
will find discomfort from local congestions on account of an 
over-activity of the heart during the period when there is no 
great physiological "wear and tear" to require a very active 
circulation. To meet these cases a course of training must 
be laid out that shall be graduated from heavy work down 
to light, so that the person may slowly accustom himself to 
the new conditions under which he must live. The heart of an 
athlete, who has been properly trained, is usually in good 
condition, and a very small percentage develop any heart 
lesion during their training, but a large over-strong heart may 
be an actual disadvantage to a man leading a sedentary life, 
as a puny, feeble heart surely is. 

The examiner will find many cases of nutritive debility and 
irritability. Among men a large per cent, of these cases will 
be inordinate users of tobacco. The very first glance will 
betray to the experienced eye the "something wrong," but we 
must always remember that some of the most persistent users 
of tobacco are strong and hearty while a few of those who do 
not use it are weak and nervous. How, then, shall we say to 
a person who asks our advice whether he is suffering from 
nicotine poisoning or not? 

In the first place the heart action under continued influence 
of nicotine is peculiar and attention is called to the sphygmo- 

gram (Fig. 61) of 
a typical pulse of 
a "tobacco heart," 
FlG - 61. from the "Refer- 

ence Handbook of the Medical Sciences." It will be noticed 
that the first two beats are essentially normal with the tidal 
wave as marked as the dicrotic. The interval between the 
second and third waves is longer than the first, which may be 
considered the normal for this case. The third interval is 
short and the dicrotic notch deep while the systolic wave is not 
high. The fourth interval is normal; the fifth longer and 




Prescription of Exercise. 183 

followed by a very faint impulse after which the heart again 
rallies, and so on. 

The character of this pulse as felt at the wrist is irregular 
and tremulous. A beat or two of high tension followed by one 
of low, or there may be no rhythm discoverable. 

These cases should be studied carefully and repeatedly to 
distinguish them from the frequent pulse of nervous excite- 
ment or the palpitation and irregularity of chronic indigestion. 
In perhaps three-fourths of the cases there will be some ner- 
vous excitement attendant on the new experiences of a thor- 
ough examination but this influence on the pulse may be 
either quickening or depressing, and these changes come dur- 
ing cycles covering many pulsations. 

An intermittent pulse may not be an indication of serious 
interference with health or longevity and may not be due to 
any appreciable cause. The omission is then usually found at 
stated intervals not very short, but from ten to a hundred 
beats apart. It is not a condition to safely endure the hard- 
ships of athletic training but vigorous exercise may be pre- 
scribed. 

Of course the examiner's duty is clear in each discov- 
ered case of smoker's irritable heart, and it is only suggested 
that other narcotic stimulants, like tea and coffee, will pro- 
duce effects that are nearly similar. In these cases the ex- 
ercise recommended must be light and such as tends to re- 
lieve the circulation. 

In studying the growth of a class in Yale, it appeared 
that if this growth be expressed in the form of percentage 
the weight of the non-users increased 10 . 4 per cent, more than 
the regular users, and 6.6 per cent, more than the occasional 
users. In the growth of height, the non-user increased 24 
per cent, more than the regular user and 12 per cent, more than 
the occasional user. In growth of chest girth the non-user 
has an advantage over the regular user of 26.7 per cent, and 
over the occasional user of 22 per cent., but in capacity of lungs, 
the growth is in favor of the non-user by 77.5 per cent, when 
compared with regular users, and 49.5 per cent, when compared 
with the irregular users. 

The matter of tobacco smoking as an influence upon the 
physical development of Amherst students has been studied 
in the history of the class of '91. Of this class 71 per cent. 



184 Prescription of Exercise. 

had increased in their measurements and tests during their 
whole course, while 29 per cent, had remained stationary or 
had fallen off. 

In separating the smokers from the non-smokers, it ap- 
pears that in the item of weight the non-smokers have in- 
creased 24 per cent, more than the smokers; in height they 
have surpassed them 37 per cent., and in chest girth, 42 per 
cent. And in lung capacity there is a difference of 8.36 cubic 
inches (this is about 75 per cent.) in favor of the non-smokers, 
which is 3 per cent, of the total average lung capacity of the 
class. 

It has long been recognized by the ablest medical authori- 
ties that the use of tobacco is injurious to the respiratory 
tract, but the extent of its influence in checking growth in 
this and in other directions has, I believe, been widely under- 
estimated. 



The Examiner Himself. 185 



CHAPTER XV. 

THE EXAMINER HIMSELF. 

And now a word in regard to the examiner himself: It is 
obvious that a medical training is of very great advantage to 
the person who is to make such physical diagnosis and meas- 
urement as shall be strictly scientific and accurate. If the 
examiner has not a medical education, let him always err on 
the safe side in a doubtful case and require a certificate from 
a physician before entering a pupil on a course of advanced ex- 
ercise, or athletic work. But first let him study the case, using 
all the light that can be thrown on it from books and the history 
that can be obtained. The examiner must be a student, he 
must learn, he must study, examining not only the client but 
books, papers, periodicals. Anything bearing on his subject 
should be studied and questioned, but not criticised until he 
is sure of some error; then let him correct the error by show- 
ing its inaccuracy of fact or logic. 

The examiner must have a thorough knowledge of an- 
atomy and physiology, for in no other way can he become 
competent to advise a person regarding either health or ex- 
ercise. To prescribe the same exercise for a person whose 
system is starved by malnutrition that we would for a person 
suffering from plethora would obviously be productive of 
unsatisfactory results both to the pupil and to the teacher. 
It must be remembered that malnutrition may be due to any 
one of several causes, and that while some of these will be 
removed or alleviated by exercise, others might be seriously 
aggravated. We must know how the machine is constructed 
and under what conditions it can work most favorably before 
we can rightly attempt to adjust its mechanism or interfere 
with its ordinary working. 

There is no longer a question of understanding Physiology 
that we may be able to care for the sick — we must know it. 
That we may direct and train the will also requires that we 
understand the law of normal action for every organ and that 
harmonious inter-relation of all that constitutes health. 
Health is of more consequence than sickness, for it 



186 The Examiner Himself. 

should be the constant condition of life varied only by the 
accidents to which all are subject. 

Science has taught us that in living organisms functional 
activity must be kept up or there will be no development. 
A group of organs unused will atrophy and become useless. 
Heredity soon stamps a deformity, that has been developed 
in two or three generations, as a type, and succeeding gen- 
erations that do not possess that peculiarity are looked upon 
almost as new varieties. This is especially true of physical 
defects that impair the vitality of the parents. Notice the 
stress laid upon this law by life insurance companies where 
business interests have no bias from sentiment. The excel- 
lent health of the applicant is not enough if there be a record 
going back two or three generations of degenerative diseases 
that have proved fatal, or if the constitutional vigor has been 
so weak as to let the life go o\it at about forty-five or fifty 
years of age from any immediate cause. 

The first lesson that we must learn from this truth is that 
health cannot exist if vital organs are seriously undeveloped. 

Health is the condition of harmonious adjustment of all 
the functional activities. For instance: a normal pulse rate 
is from 72 to 76 beats per minute under ordinary conditions 
of rest ; but a pulse-rate of 72 after a half-mile run might be 
considered abnormal and the ground for solicitude — for health 
would demand an increased activity of the heart muscle to 
supply increased blood currents to the active muscles, that 
waste products may be eliminated and restorative elements 
supplied. But further: an adjustment of the pulse rate is 
not all that is to be required in the case cited, for there must 
be a corresponding increase of respiration for elimination 
and oxidation. And so the perfect activity of any organ — 
even the brain — may be- shown to be dependent on the healthy 
activity of other organs, while the converse may be stated 
as a physiological truth, viz. : that the imperfect action of any 
organ impairs the function of all others to some extent. A 
healthy muscle is, then, dependent on a healthy stomach, heart 
and brain, no less than on good food, air, etc., while the more 
refined intellectual processes are also based on a normal 
condition of the physical organs. 

So practical a business man as the Hon. Thomas G. Shear- 
man says: "I do not underrate the value of pure mental 



The Examiner Himself. 187 

training, especially as that is nearly all which I have myself 
received; but my very lack of training in physical labor has 
led me to observe the great value which it has, not merely 
with reference to bodily health and strength, but for the very 
purpose of enlarging the mental faculties."* 

A system of education that has in view the symmetrical 
relations of mental and physical qualities, cannot ignore the 
necessity of beginning physical training with the mental. The 
child should come under the care of an experienced instructor 
in physical training from the day of entrance to regular school 
life. A physical examination should be made that should 
determine the condition of heart, lungs., spine, muscles, skin, 
eyes and ears. Many a case of incipient disease that event- 
uates in disaster, would be discovered and put in the care of a 
physician if necessary, or a correct regimen inaugurated with 
the aid of the parents, that w^ould counteract the tendency 
to disease or deformity and save the child as a useful member of 
society. 

To undertake this important duty will be the function of 
the physical director and the preparation should be careful 
and constant. Let no teacher look upon his position as a 
sinecure. There is work to be done in every field. 

Do not permit the self-satisfaction of conceit to spoil your 
ability for work. 

Do not take the statement of anybody as infallible. If it 
clashes with your own idea, examine it and decide who is 
wrong. 

Do not run after everything new and think that the new 
apparatus will make exercise a pleasure and relieve you of 
your work, or the new idea will save you the trouble of thinking. 

Do not go through your work in a perfunctory sort of a 
way, but be enthusiastic and full of interest in those with 
whom you come into the relationship of adviser and instructor. 

Be earnest, careful and exact, filled with the spirit of hard 
work, or move on to some less onerous occupation. 

Do not try to find some fault with each person who comes 
under your care, nor continually decry habits that you be- 
lieve to be bad. If you believe, as I do, that the use of tobacco 



*Report of third annual meeting of American Economic Association, 
Philadelphia, 1889. 



188 The Examiner Himself. 

is injurious to the majority of smokers, do riot tell every person 
whose breath, "gives him away," that he is "killing himself" 
by smoking, or that he has the "smoker's heart" and must 
reform at once if he wishes to rob the grave of an early victim; 
for in every such case either you will be informed that 
the smoker has no desire to go into the business of robbing 
graA^es or you will be set down as a bigot whose opinion is good 
for nothing, and whose advice is worth still less. If a person 
asks you if you think tobacco was hurting him, and you find no 
indication of injury, be honest enough to tell him so, and your 
candor will so establish his confidence in you that the subse- 
quently expressed opinion that tobacco has done him no good, 
will be likely to set him to thinking. At times you are expected 
to express yourself freely, as when lecturing on any subject, 
but do not try to pour a lecture into the unwilling ears of every 
one who may chance to fall into your hands. You do no good, 
but make yourself ridiculous. 

Establish a record for honesty and ability and your advice 
will be sought. Integrity is the largest factor in influence. 

Endeavor to find out the actual condition of each organ 
and do not be too quick to decide on the cause of any abnor- 
mality. If the heart action is imperfect and the person uses 
tobacco, remember that there are occasionally "bad" hearts 
in those who have never "used the weed." A lateral curva- 
ture of the spine also may be due to no muscular inefficiency 
or weakness but may indicate good muscular action, as in 
case of a shorter leg on one side. 

Do not be boastful and proudly claim to have discovered 
a new "system" or a "natural" system of exercise because 
you have by a certain method of life acquired a large biceps 
or general good physique. Your size of arm may have as 
little relation to any system as your size of hat. Because Dr. 
Tanner lived forty days without food he did not establish a 
system of living without food, and because some "Prof." can 
live comfortably by breathing only three times a minute it 
does not follow that he has a "system" all his own; a turtle 
can live all winter on one breath. 

Be conservative and at the same time progressive. Ex- 
amine all that is new, but before you adopt it test it by eveiy 
standard that you can bring into comparison with it. Re- 
member that you will probably not discover a great 



The Examiner Himself. 189 

number of new truths, nor will you undermine and overthrow 
many of the commonly accepted theories and doctrines that 
have been enunciated in the past. 

Be modest, then, and learn much from others, claiming 
very little as entirely new and your own. At the same time 
it is well to remember that this science and art of Physical 
Education or Training is in its infancy, in this country at 
least, and there is much work that is experimental and tenta- 
tive. 

Perhaps in no field of scientific research bearing directly 
on practical medicine is more to be discovered and demon- 
strated than in kinetic physiology. . The influence of exercise 
on muscle, bone, nerve and connective tissue is not fully under- 
stood — in fact we are only working at the alphabet of the 
science as it will be developed. Much injury to progress has 
been caused by superficial observation and extravagant claims 
for "systems" and methods that had produced fair results 
apparently with a select few and were then loudly proclaimed 
as a complete scientific exposition of the whole subject when 
they barely rested on a single correct principle or physiological 
truth. When the enthusiasm of the originator had died out 
the illumination was found to be meteoric and a general distrust 
was established. 

A quack in a community injures the reputation of every 
honest practitioner in it. Be content, then, to work a great 
deal and claim very little. Have a scientific theory as a basis 
of your work, but be ready to amend it at any time. Study 
your material and you will find so many facts to be classified 
and arranged that you will have little time to electrify the 
world by some universal specific. If you have no material 
and do not work you will have all the more time to invent 
some startling method that shall make you rich with the money 
of fools but leave science the poorer by a filching of her name 
and reputation. 

Remember that you owe something to your profession. 
Try to pay some part of this debt each year by some contri- 
bution to its science or its literature. 



190 



Addenda. 



ADDENDA. 

In studying recently the measurements of some 15,000 Yale 
students, whose records were grouped according to ages, some 
interesting facts appeared that it seems wise to call to the 
attention of those who are interested in tabulating the records 
of somewhat similar groups. 

From the data gathered and published by Dr. Gould, in 
the report, of the Sanitary Commission after the Civil War, 
it appeared that the total height of men was not attained 
until the age of twenty-seven. When the individual is studied 
the same rule seems to hold good, for many men grow in a 
measurable degree until the above age is reached and some 
continue growth even later. But there seems to be no cor- 
responding evidence that some men undergo a diminution in 
size before the age that is usually considered the limit of skeletal 
growth. 

In the percentile tabulation of the 15,000 records of students 
who were measured at Yale between 1883 and 1904 the 50% 
records appear as follows: 



Year . . 


17th 


18th 


19th 20th 


21st 


22nd 


23rd 


24th 


25th 


25 + 


Weight 


128 


133 


136 


138 


139.5 


143.5 


143.7 


143.5 


142.5 


139 . 5 


Height 


1717 


1720 


1730 


1730 


1732 


1736 


1731 


1730 


1725 


1720 


Trunk 


890 


902 


904 


908 


912 


912 


912 


910 


909 


906 


Chest 


891 


907 


911 923 


930 


940 


942 


944 


945 


944 



The item of weight is reduced to English units while the 
others are in metric form, as the variations are more clearly 
apparent in this way. It should also be said that this collection 
of statistics includes the records of essentially every man who 
entered the Academic department for eighteen years, and 
seventy-five per cent, of them for three years; it also includes 
the records of all of the men who entered the Scientific depart- 
ment for four years and sixty per cent, of them for seventeen 
years. The other records are of members of the Graduate 
Schools. 

It appears from the class statistics that the average age 
of the great majority of these men at graduation is in the twenty- 
third year for the Academic men and in the twenty-second 
year for the Scientific men. The Graduate students are older 
and may be supposed to enter the University at about the same 
age that marks the graduation of the others. As many of 
these men come from other institutions to the Graduate Schools, 
it will be clear that the records of men over twenty-three years 
of age are made up from a somewhat different group from the 
candidates for the degree of A. B. or Ph. B., and consist of men 



Addenda. 191 

who enter the undergraduate courses somewhat late in life, 
and those who continue their studies after having received 
the bachelor's degree at Yale or elsewhere. The physical 
type of the two groups varies in a very marked manner as 
shown by this table, and several points seem clearly demon- 
strated : 

First, the percentile method discloses the type of the 
group that is being studied in a much clearer manner than a 
tabulation by the method of averages, where a few very large, 
or very small men would conceal the type. Second, it demon- 
strates that the study of great numbers of such statistics of 
growing men can never determine a fixed mean for the different 
ages, and thus show the law of growth, by the percentile method 
of tabulation. Third, the type of man who continues in Univer- 
sity instruction is smaller than of the man who ends his career 
as a student on receiving the bachelor's degree. Fourth, 
there may be a question as to the smaller size of the advanced 
students; is there a natural conflict between scholarship and 
growth of body? Are the lives of "hard students" essentially 
abnormal? Do the men of poor vitality and physical power 
seek to help themselves in the competition of life by more 
extensive mental training and do they seek professional life 
rather than the more active and competitive occupations? 
Fifth, if these questions have to be answered in the affirmative , 
may it not account for the lack of fertility of this group, as has 
been pointed out by President Eliot and others ? If the methods 
of modern education tend to impair physical efficiency, should 
there not be a wider recognition of the fact, and more 
earnest effort made toward the reform of these methods, and 
pedagogy be brought into more definite relation to, if not 
dependence upon, physiology? 



BIBLIOGRAPHY. 



, Aitken, William. On the Growth of the Recruit and the Young Soldier, 
London, 1862. 

. Audran, Gerald. Les proportions du corp humain mesur^es sur les 
belles figures de l'antiquite. 1863. 

Baxter, A. M. Statistics, Medical and Anthropological: Reports of the 
Provost-Marshal-General's Bureau, U. S. 

. Beard, G. M. English and American Physique. N. Am. Rev., CXXXIX. 
588-603. 

Beddoe, Dr. John. On the Stature and Bulk of Man in the British Isles. 
Mem. Anthrop. Soc. Vol. III. 

- Bemies, C. O. The Physicial Characteristics of the Runner and Jumper. 
Am. Phys. Ed. Review. Sept., 1900. 

Bertillon, Alphonse. Les Proportions du Corps Humain. Revue 
Scientifique, 1889. 

Anthropometric Identification, 1896. 

Bertillon, J. Cours Elementaire de Statistique, 1895. 

Beyer, H. G. Observations on Normal Growth and Development of the 
Human Bodv under Systematized Exercise. Report of the Surg. 
Gen. of the U. S. N., 1893. 

The Growth of the U. S. Naval Cadets. Proc. of the U. S. Naval 
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The Influence of Exercise on Growth. Ibid. Vol. XXII. 

Boas, F. Anthropological Investigations in Schools. Pedagogical 
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Physical Characteristics of the Indians of the North Pacific Coast. 
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i Bowditch, H. P. The Growth of Children. Report of Mass. Board of 
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The Growth of Children. Ibid. 1879. Ibid. 1891. 

The Physique of Women in Massachusetts. Ibid. 1889. 

The Growth of Children Studied by Galton's method of percentile 
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Bowley, A. L. Elements of Statistics. 1901. 

t Bradford, E. H. The Effect of Recumbency on the Length of the Spine 
Bost. Med. and Surg. Jour., Vol. CIX. 



ii Bibliography. 

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• Greenleaf. New Table of Physical Proportions. Bait. Underwriter, 

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« Hanna, Delphine. Anthropometric Table in Percentile Form from the 
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Bibliography. iii 

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iv Bibliography. 

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Anthropometric Table Compiled in Percentile Form from the 
Measurements of 1600 Wellesley Students. 1893. 



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